NATIONAL INTEGRATED MICRONUTRIENT

AND ANTHROPOMETRY SURVEY

OF THE KYRGYZ REPUBLIC 2021 (NIMAS)
REPORT
October 2022
NATIONAL INTEGRATED MICRONUTRIENT
AND ANTHROPOMETRY SURVEY OF
THE KYRGYZ REPUBLIC 2021 (NIMAS)
REPORT
October 2022
Recommended Citation: Ministry of Health, UNICEF, WFP, FAO, WHO, USAID, Advancing Nutrition-USAID, Mercy
Corps-USDA, and GroundWork. National Integrated Micronutrient and Anthropometry Survey 2021. Bishkek,
Kyrgyz Republic; 2022.
 REPORT- OCTOBER 2022

INVESTIGATORS AND INSTITUTIONAL AFFILIATIONS

Principal Investigator Organization

Bekturganov Ulugbek Deputy Minister of Health and Social Development of the Kyrgyz Republic
Survey Coordinator
Bermet Sydygalieva UNICEF – Health and Nutrition Officer
Co-Investigators
Nicolai Petry GroundWork
James P Wirth GroundWork
Rita Wegmüller GroundWork
Sabina Rustamova-Aliyeva GroundWork
Bradley Woodruff GroundWork
Fabian Rohner GroundWork
William E.S. Donkor GroundWork
Valeria Galetti GroundWork
Sherzod Dadazhanov UNICEF/ GroundWork
Zhamala Umankulova Erfolg
Ainura Akmatova Head of Public Health Department, Department on Medical Care and Public
Health, Ministry of Health and Social Development
Baktygul Ismailova Chief Specialist, Department on Medical Care and Public Health, Ministry of
Health and Social Development
Gerrit Maritz Chief of Child Survival and Development, UNICEF
Uma Kandalaeva Country Director, Mercy Corps
Olga Creamer Monitoring and Evaluation Manager, Mercy Corps
Nurzat Esengulova Director of Programs, Mercy Corps
Nazgul Abazbekova Country Director, USAID/Advancing Nutrition
Keigo Obara Food Security Officer, FAO Sub-Regional Office for Central Asia
Hilke David WFP, Deputy Country Director
Manuela Tolmino WFP, Nutrition Specialist
Nurshaim Tilenbaeva National Professional Officer for SRMNCAH, WHO
Gulzat Maimerova Director, National Mother and Child Care Center
Galina Samohleb National Statistic Committee

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

TABLE OF CONTENTS

ACKNOWLEDGEMENTS 1
ABBREVIATIONS 1
EXECUTIVE SUMMARY 1
• Укрепление продовольственной безопасности и сокращение бедности 4
• Внесение поправок в закон о йодировании соли 5
• Укрепление программы обогащения пшеничной муки 5
• Decrease распространенности избыточного веса и ожирения 5
INTRODUCTION 6
1.1. Country overview 1
1.2. Nutritional situation of the Kyrgyz population 1
1.3. Programs to combat micronutrient deficiencies in the Kyrgyz Republic 4
1.4. Rationale for the survey 5
1.5. Objectives 5
1.5.1. Primary objectives 5
1.5.2. Secondary objectives 6
2. METHODOLOGY 7
2.1. Geographic scope and basic sampling frame 7
2.2. Sampling approach and sample size determination 8
2.3. Study populations 8
2.4. Ethical considerations 9
2.5. Field work and data collection 10
2.5.1. Mapping and listing 10
2.5.2. Training of survey teams and field testing 10
2.5.3. Community mobilization and sensitization 11
2.5.4. Field work: Interviews 12
2.5.5. Field work: Anthropometry and phlebotomy 12
2.5.6. Cold chain and processing of blood samples 13
2.5.7. Supervision of fieldwork 14
2.6. Definitions of indicators and specimen analysis 14
2.6.1. Infant and young child feeding indicators
2.6.2. Anthropometric indicators 14
2.6.3. Blood and urine specimens 15
2.6.4. Food samples 19
2.7. Data management and analysis 21
2.7.1. Data entry 21

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2.7.2. Data monitoring 21

2.7.3. Data analysis 21
3. RESULTS 24
3.1. Study participation of households, children, and women 24
3.2. Household characteristics 26
3.2.1. Demographic characteristics 26
3.2.2. Cooking fuel and household lighting 28
3.2.3. Household food insecurity 28
3.2.4. Water and sanitation 31
3.2.5. Salt iodization 33
3.2.6. Bread and flour types and iron fortification 39
3.2.7. Covid-19 pandemic impact on participating households 43
3.3. Children 6-59 month of age 47
3.3.1. Characteristics 47
3.3.2. Recent illness and health indicators 48
3.3.3. Infant and young child feeding indicators 49
3.3.4. Dietary diversity in children 6-23 months of age 50
3.3.5. Consumption of vitamins, minerals, supplements, and fortified foods 51
3.3.6. COVID 19 and child feeding practices 52
3.3.7. Stunting 53
3.3.8. Wasting, overweight and obesity 57
3.3.9. Underweight 61
3.3.10. Microcephaly
3.3.11. Anemia, iron deficiency, and iron deficiency anemia 62
3.3.12. Vitamin A deficiency 67
3.3.13. Vitamin D deficiency 69
3.3.14. Associations between micronutrient deficiencies and various factors 70
3.4. Children 5-9 years of age 75
3.4.1. Characteristics 75
3.4.2. Schooling and school feeding 76
3.4.3. Recent illness and health indicators 76
3.4.4. Dietary diversity 77
3.4.5. Consumption of vitamins and supplements 78
3.4.6. Short stature 79
3.4.7. Thinness, overweight and obesity 82
3.4.8. Underweight 85
3.4.9. Anemia, iron deficiency, and iron deficiency anemia 87
3.4.10. Vitamin A deficiency 91
3.4.11. Associations between micronutrient deficiencies and various factors 92

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.5. Adolescent girls 96

3.5.1. Characteristics 96
3.5.2. Recent illness and health indicators 96
3.5.3. Dietary diversity 97
3.5.4. Consumption of vitamins and supplements 98
3.5.5. Short stature 100
3.5.6. Thinness, overweight and obesity 102
3.5.7. Anemia, iron deficiency, and iron deficiency anemia 105
3.5.8. Vitamin A deficiency 109
3.5.9. Folate deficiency 110
3.5.10. Vitamin D deficiency 111
3.5.11. Iodine deficiency 113
3.5.12. Associations between micronutrient deficiencies and various factors 114
3.6. All females 15-49 years of age 121
3.6.1. Pregnancy and birth history 121
3.7. Non-pregnant women of reproductive age 122
3.7.1. Characteristics 122
3.7.2. Dietary diversity 123
3.7.3. Consumption of vitamins and supplements 123
3.7.4. Anthropometry 125
3.7.5. Anemia, iron deficiency, and iron deficiency anemia 130
3.7.6. Vitamin A deficiency 134
3.7.7. Folate deficiency 135
3.7.8. Vitamin D deficiency 136
3.7.9. Iodine deficiency 137
3.7.10. Associations between micronutrient deficiencies and various factors 140
3.8. Pregnant women 146
3.8.1. Characteristics 146
3.8.2. Dietary diversity and consumption of vitamins and mineral supplements 147
3.8.3. Mid-upper arm circumference 147
3.8.4. Anemia 147
3.8.5. Iodine deficiency 149
4. DISCUSSION AND CONCLUSIONS 150
4.1. Household level findings 150
4.2. Under- and overnutrition 151
4.3. Anemia and iron deficiency 152
4.4. Vitamin A deficiency 153
4.5. Folate deficiency 153
4.6. Vitamin D deficiency 154

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4.7. Iodine deficiency 154

5. STRENGTHS AND LIMITATIONS 154
6. RECOMMENDATIONS 156
6.1. Reduce poverty 156
6.2. Improve household access to food
6.3. Amend the salt iodization law 156
6.4. Strengthen wheat flour fortification 157
6.5. Reduce the prevalence of overweight and obesity 157
6.5.1. Strengthen other strategies to tackle micronutrient deficiencies
6.5.2. National Nutrition Information System
7. REFERENCES 159
8. APPENDICES 165
8.1. ADDITIONAL HOUSEHOLD TABLES 166
8.2. ADDITIONAL CHILD TABLES 169
8.3. ADDITIONAL SCHOOL CHILD TABLES 171
8.4. ADDITIONAL ADOLESCENT GIRL TABLES 173
8.5. ADDITIONAL WOMAN TABLES 175
8.6. COMPARISON OF PLASMA RETINOL AND PLASMA RETINOL BINDING PROTEIN 177
8.7. HEMOGLOBIN COMPARISON – HEMOCUE 301 AND COMPLETE BLOOD COUNT 179
8.8. A PRIORI SAMPLE SIZE CALCULATIONS 181
8.9. ETHICAL APPROVAL 182
8.10. INFORMATION SHEET AND CONSENT FORM 185
8.11. AUTHORIZATION LETTER FROM MINISTRY OF HEALTH 189
8.12. TEAMS, TEAM MEMBERS, AND SUPERVISORS 190
8.13. SURVEY QUESTIONNAIRES 191
8.14. REFERRAL FORM 192
8.15. ANTHROPOMETRY – NIMAS: ENA PLAUSIBILITY CHECK REPORT
8.16. DESIGN EFFECTS OF MAJOR OUTCOMES 193

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

LIST OF FIGURES

Figure 1. Kyrgyz Republic’s administrative zones and PSUs selected for NIMAS 7

Figure 2. Participation flow diagram for households, women, adolescent girls and children, the 25
Kyrgyz Republic 2021

Figure 3. Proportion of households with adequate sanitation facilities, by region 32

Figure 4. Salt iodine concentration by categories not iodized (0-<5ppm), inadequately iodized 35
(5-14.9ppm) and adequately iodized (≥ 15 ppm), the Kyrgyz Republic 2021

Figure 5. Distribution of household salt iodine concentrations, the Kyrgyz Republic 2021 35

Figure 6. Proportion of households with adequate salt iodization (≥15 ppm), by region, the 39
Kyrgyz Republic 2021

Figure 7. Flour fortification with iron by categories not fortified, inadequately fortified and 43
adequately fortified, the Kyrgyz Republic 2021

Figure 8. Proportion of households with fortified wheat flour, by region, the Kyrgyz Republic 43
2021

Figure 9. Distribution of height-for-age z-scores in children 6-59 months of age, the Kyrgyz 54
Republic 2021

Figure 10. Prevalence of stunting by region, children 6-59 months, the Kyrgyz Republic 2021 54

Figure 11. Distribution of weight-for-height z-scores in children 6-59 months of age, the Kyrgyz 57
Republic 2021

Figure 12. Distribution of adjusted hemoglobin (g/L) in children 6-59 months of age, the Kyrgyz 63
Republic 2021

Figure 13. Venn diagram showing overlap between anemia and iron deficiency in children 6-59 64
months of age, the Kyrgyz Republic 2021

Figure 14. Distribution of height-for-age z-scores in children 5-9 years of age, the Kyrgyz 80
Republic 2021

Figure 15. Prevalence of overweight and obesity in children 5-9 years of age, the Kyrgyz Republic 82
2021

Figure 16. Distribution of weight-for-age z-scores in children 5-9 years of age, the Kyrgyz 85
Republic 2021

Figure 17. Distribution of adjusted hemoglobin (g/L) in children 5-9 years, the Kyrgyz Republic 87
2021

Figure 18. Venn diagram showing overlap between anemia and iron deficiency in children 5-9 88
years of age, the Kyrgyz Republic 2021

Figure 19. Distribution of height-for-age z-scores in adolescent girls 10-18 years of age, the 100
Kyrgyz Republic 2021

Figure 20. Distribution of adjusted hemoglobin (g/L) in adolescent girls 10-18 years of age, the 105
Kyrgyz Republic 2021

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 REPORT- OCTOBER 2022

Figure 21. Venn diagram showing overlap between anemia and iron deficiency in adolescent 106
girls 10-18 years old age, the Kyrgyz Republic 2021

Figure 22. Geographic distribution of median urinary iodine concentration in adolescent girls, 114
the Kyrgyz Republic 2021

Figure 23. Prevalence of underweight, normal weight, overweight and obesity in non-pregnant 125
women 15-49 years of age, the Kyrgyz Republic 2021

Figure 24. Prevalence of underweight, normal weight, overweight, and obesity in non-pregnant 126
women 15-49 years of age, by age group, the Kyrgyz Republic 2021

Figure 25. Distribution of BMI values in non-pregnant women 15-49 years of age, The Kyrgyz 127
Republic 2021

Figure 26. Distribution of adjusted hemoglobin (g/L) in non-pregnant women 15-49 years of age, 130
the Kyrgyz Republic 2021

Figure 27. Venn diagram showing overlap between anemia and iron deficiency in non-pregnant 131
women 15-49 years of age, the Kyrgyz Republic 2021

Figure 28. Geographic distribution of median urinary iodine concentration in non-pregnant non- 138
lactating women 15-49 years of age, the Kyrgyz Republic 2021

Figure 29. Geographic distribution of median urinary iodine concentration in non-pregnant 140
lactating women 15-49 years of age, the Kyrgyz Republic 2021

Figure 30. Distribution of hemoglobin (g/L) in pregnant women, the Kyrgyz Republic 2021 148

Figure 31. Combined comparison of retinol and retinol binding protein concentrations in children 178
6-59 months of age (PSC), children 5-9 years of age (SAC), and adolescent girls and
non-pregnant women (AG-NPW), the Kyrgyz Republic 2021

Figure 32. Comparison of hemoglobin measured using Hemocue 301 and complete blood count 179
in in children 6-59 months of age (PSC), children 5-9 years of age (SAC), and women
of reproductive age (WRA), the Kyrgyz Republic 2021

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

LIST OF TABLES

Table 1. Summary results of the NIMAS 2021 xv

Table 2. Prevalence estimates for nutrition-relevant data in the recent past in the Kyrgyz 3
Republic
Table 3. Inclusion criteria by targeted population group 9
Table 4. Clinical cut-off points and classifications for biomarker indicators 16
Table 5. Adjustments in cut-off defining anemia, by altitude of residence [43] 17
Table 6. Adjustments in cut-off defining anemia, by smoking status (Adapted from [44]) 17
Table 7. Characteristics of participating households, the Kyrgyz Republic 2021 26
Table 8. Household composition of participating households, the Kyrgyz Republic 2021 27
Table 9. Educational level of household head for participating households, the Kyrgyz 28
Republic 2021
Table 10. Type of energy used for cooking, lighting and heating in participating households, 29
the Kyrgyz Republic 2021
Table 11. Household food insecurity score (HFIAS) categories, by residence, region, and 30
wealth quintile, the Kyrgyz Republic 2021
Table 12. Indicators of household water and sanitation, the Kyrgyz Republic 2021 31
Table 13. Indicators of handwashing, the Kyrgyz Republic 2021 32
Table 14. Household salt availability, and packaging, the Kyrgyz Republic 2021 34
Table 15. Proportion of households in which salt was iodized a and adequately iodized a, the 37
Kyrgyz Republic 2021
Table 16. Household bread consumption, the Kyrgyz Republic 2021 39
Table 17. Household wheat flour consumption, the Kyrgyz Republic 2021 40
Table 18. Proportion of households with fortified a and adequately a fortified flour, the Kyrgyz 41
Republic 2021
Table 19. Effect of the COVID-19 outbreak on participating households, the Kyrgyz Republic 45
2021
Table 20. Effect of COVID-19 on food access and consumption of participating households, 46
the Kyrgyz Republic 2021
Table 21. Description of children 6-59 months of age, the Kyrgyz Republic 2021 47
Table 22. Health indicators in children 6-59 months of age, the Kyrgyz Republic 2021 48
Table 23. IYCF indicators in children 6-23 months of age (unless stated otherwise), the 49
Kyrgyz Republic 2021
Table 24. Dietary diversity in children 6-23 months of age, the Kyrgyz Republic 2021 50
Table 25. Consumption of iron-fortified food, vitamin A and vitamin D supplements in 51
children 6-59 months of age, the Kyrgyz Republic 2021
Table 26. Effect of COVID-19 pandemic on child feeding practices among children 6-59 52
months of age, the Kyrgyz Republic 2021

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Table 27. Percentage of children (6-59 months) with stunting, the Kyrgyz Republic 2021 55
Table 28. Percentage of children (6-59 months) with wasting, the Kyrgyz Republic 2021 58
Table 29. Prevalence of overweight and obesity in children 6-59 months of age, by various 60
demographic characteristics, the Kyrgyz Republic 2021
Table 30. Prevalence of anemia, iron deficiency, and iron deficiency anemia in children 6-59 61
months of age, by various demographic characteristics, the Kyrgyz Republic 2021
Table 31. Prevalence of vitamin A deficiency in children 6-59 months, by various demographic 65
characteristics, the Kyrgyz Republic 2021
Table 32. Prevalence of vitamin D deficiency in children 6-59 months of age, by various 67
demographic characteristics, the Kyrgyz Republic 2021
Table 33. Correlation between various factors and anemia in children 6-59 months of age, 69
the Kyrgyz Republic 2021
Table 34. Correlation between various factors and iron deficiency in children 6-59 months of 70
age, the Kyrgyz Republic 2021
Table 35. Correlation between various factors and vitamin A deficiency in children 6-59 71
months of age, the Kyrgyz Republic 2021
Table 36. Correlation between various factors and vitamin D deficiency in children 6-59 73
months of age, the Kyrgyz Republic 2021
Table 37. Description of children 5-9 years of age, the Kyrgyz Republic 2021 74
Table 38. Schooling and school feeding of children 5-9 years of age, the Kyrgyz Republic 2021 75
Table 39. Health indicators in children 5-9 years of age, the Kyrgyz Republic 2021 76
Table 40. Dietary diversity in children 5-9 years of age, the Kyrgyz Republic 2021 77
Table 41. Consumption of iron, vitamin A and vitamin D supplements in children 5-9 years of 78
age, the Kyrgyz Republic 2021
Table 42. Percentage of children 5-9 years of age with short stature, the Kyrgyz Republic 79
2021
Table 43. Prevalence of thinness, overweight and obesity in children 5-9 years of age, the 81
Kyrgyz Republic 2021
Table 44. Percentage of children 5-9 years of age with underweight, the Kyrgyz Republic 2021 83
Table 45. Prevalence of anemia, iron deficiency, and iron deficiency anemia in children 5-9 86
years of age, by various demographic characteristics, the Kyrgyz Republic 2021
Table 46. Prevalence of vitamin A deficiency in children 5-9 years of age, by various 89
demographic characteristics, the Kyrgyz Republic 2021
Table 47. Correlation between various factors and anemia in children 5-9 years of age, the 91
Kyrgyz Republic 2021
Table 48. Correlation between various factors and iron deficiency in children 5-9 years of 92
age, the Kyrgyz Republic 2021
Table 49. Correlation between various factors and vitamin A deficiency in children 5-9 years 94
of age, the Kyrgyz Republic 2021
Table 50. Description of adolescent girls 10-18 years of age, the Kyrgyz Republic 2021 95
Table 51. Health indicators in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021 96
Table 52. Dietary diversity in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021 97

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Table 53. Consumption of mineral and vitamin supplements in adolescent girls 10-18 years 97
of age, the Kyrgyz Republic 2021
Table 54. Percentage of adolescent girls 10-18 years of age with short stature, the Kyrgyz 98
Republic 2021
Table 55. Prevalence of thinness, overweight and obesity in adolescent girls 10-18 years of 101
age, the Kyrgyz Republic 2021
Table 56. Prevalence of anemia, iron deficiency, and iron deficiency anemia in adolescent 103
girls 10-18 years, by various demographic characteristics, the Kyrgyz Republic
2021
Table 57. Prevalence of vitamin A deficiency in adolescent girls 10-18 years of age, by various 107
demographic characteristics, the Kyrgyz Republic 2021
Table 58. Prevalence of folate deficiency in adolescent girls 10-18 years of age, by various 109
demographic characteristics, the Kyrgyz Republic 2021
Table 59. Prevalence of vitamin D deficiency in adolescent girls 10-18 years of age, by various 110
demographic characteristics, the Kyrgyz Republic 2021
Table 60. Median urinary iodine concentration in adolescent girls 10-18 years of age, the 111
Kyrgyz Republic 2021
Table 61. Correlation between various factors and anemia in adolescent girls 10-18 years of 113
age, the Kyrgyz Republic 2021
Table 62. Correlation between various factors and iron deficiency in adolescent girls 10-18 115
years of age, the Kyrgyz Republic 2021
Table 63. Correlation between various factors and vitamin A deficiency in adolescent girls 116
10-18 years of age, the Kyrgyz Republic 2021
Table 64. Correlation between various factors and folate deficiency in adolescent girls 10-18 117
years of age, the Kyrgyz Republic 2021
Table 65. Correlation between various factors and vitamin D deficiency in adolescent girls 118
10-18 years of age, The Kyrgyz Republic 2021
Table 66. Distribution of pregnancy and birth variables in all females 10-49 years of age, the 120
Kyrgyz Republic 2021
Table 67. Description of non-pregnant women 15-49 years of age, the Kyrgyz Republic 2021 121
Table 68. Dietary diversity in non-pregnant women 15-49 years of age, the Kyrgyz Republic 122
2021
Table 69. Consumption of vitamin and mineral supplements in non-pregnant women 15-49 123
years of age, the Kyrgyz Republic 2021
Table 70. Prevalence of low and high BMI in non-pregnant women 15-49 years of age, by 124
various demographic characteristics, the Kyrgyz Republic 2021a
Table 71. Prevalence of anemia, iron deficiency, and iron deficiency anemia in non-pregnant 128
women 15-49 years of age, by various demographic characteristics, the Kyrgyz
Republic 2021
Table 72. Prevalence of vitamin A deficiency in non-pregnant women 15-49 years of age, by 132
various demographic characteristics, the Kyrgyz Republic 2021
Table 73. Prevalence of folate deficiency in non-pregnant women 15-49 years of age by 134
various demographic characteristics, the Kyrgyz Republic 2021
Table 74. Prevalence of vitamin D deficiency in non-pregnant women 15-49 years of age, by 135
various demographic characteristics, the Kyrgyz Republic 2021

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Table 75. Median urinary iodine concentration in non-pregnant non-lactating women 15-49 136
years of age, the Kyrgyz Republic 2021
Table 76. Median urinary iodine concentration in non-pregnant lactating women 15-49 years 137
of age, the Kyrgyz Republic 2021
Table 77. Correlation between various factors and anemia in non-pregnant women 15-49 139
years of age, the Kyrgyz Republic 2021
Table 78. Correlation between various factors and iron deficiency in non-pregnant women 141
15-49 years of age, the Kyrgyz Republic 2021
Table 79. Correlation between various factors and vitamin A deficiency in non-pregnant 142
women 15-49 years of age, the Kyrgyz Republic 2021
Table 80. Correlation between various factors and folate deficiency in non-pregnant women 143
15-49 years of age, the Kyrgyz Republic 2021
Table 81. Correlation between various factors and vitamin D deficiency in non-pregnant 144
women 15-49 years of age, the Kyrgyz Republic 2021
Table 82. Description of pregnant women, the Kyrgyz Republic 2021 145
Table 83. Dietary diversity and consumption of vitamin and mineral supplement in pregnant 146
women, the Kyrgyz Republic 2021
Table 84. Prevalence of anemia in pregnant women, by various demographic characteristics, 147
the Kyrgyz Republic 2021
Table 85. Median urinary iodine concentration in pregnant women, the Kyrgyz Republic 2021 148
Table 86. Distribution of household interview results for households randomly selected for 149
participation, the Kyrgyz Republic 2021
Table 87. Agricultural land and livestock of participating households, Kyrgyzatan 2021 166
Table 88. Household food insecurity score (HFIAS) categories, by residence, region, and 167
wealth quintile, the Kyrgyz Republic 2021
Table 89. Proportion of mild, moderate and severe anemia in children 6-59 months of age, 168
the Kyrgyz Republic 2021
Table 90. Proportion of mild, moderate and severe anemia in school children 5-9 years of 169
age, the Kyrgyz Republic 2021
Table 91. Proportion of mild, moderate and severe anemia in adolescent girls 10-18 years of 171
age, the Kyrgyz Republic 2021
Table 92. Proportion of mild, moderate, and severe anemia in non-pregnant women (15-49 173
years), the Kyrgyz Republic 2021
Table 93. Assumptions and results of sample size calculation, including conversion to 175
number of households, and the anemia precision obtained by the planned sample
size of 3465 households, by target group, taking into account household and
individual response rates

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

ACKNOWLEDGEMENTS

The National Integrated Micronutrient and Anthropometry Survey of the Kyrgyz Republic (NIMAS) 2021 was
accomplished thanks to commitments in the form of technical or financial support from several national and
international stakeholders:

• The Ministry of Health of the Kyrgyz Republic (MoH) supported the implementation of the survey through
selection and deployment of medical workers, sensitization activities and facilitated access to the MoH’s
infrastructure.

• National Statistical Committee (NSC) provided technical support during planning of the survey;

• UNICEF Kyrgyzstan provided technical and financial support and coordinated the implementation of the
survey;

• The implementation of the NIMAS and this report are the result of a joint effort by a number of individuals,
institutions and organisations contributing through their professional knowledge and commitment, and
would have been impossible without the financial and technical support of FAO, WFP, WHO, USAID, USAID/
Advancing Nutrition project and USDA/Mercy.

• Erfolg recruited and coordinated non-medical field teams under USDA/Mercy Corps financial support;

• GroundWork provided technical expertise during the planning and implementation of the survey, including
the development of the scientific protocol and questionnaires, the programming of the electronic data
collection system, and the training of all the survey workers. Subsequently, GroundWork monitored and
analyzed the data, managed the laboratory analyses, funded the retinol analyses, and wrote the first ver-
sion of this report.

We are also grateful to the many individuals and institutions whose support and commitment made this survey
a reality in the field. First and foremost, we thank the women, caregivers and children who participated in the
survey. We also acknowledge the field workers (supervisors, interviewers, phlebotomists, anthropometrists,
and drivers) who conducted the fieldwork despite the many challenges encountered on the ground. We also
thank Hanqi Luo from the BRINDA project for providing guidance on adjusting ferritin and RBP concentrations
for inflammation in children 5-9 years of age and adolescent girls.

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ABBREVIATIONS

AG Adolescent girls
AGP α-1-acid glycoprotein
BMI Body mass index
BRINDA Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia
CBC Complete Blood Count
CI Confidence Interval
CRP C-reactive protein
DHS Demographic and Health Survey
ELISA Enzyme linked immunosorbent assay
HAZ Height-for-age z-score
HH Household
HPLC High-pressure liquid chromatography
ID Iron Deficiency
IDA Iron Deficiency Anemia
IYCF Infant and young child feeding
MICS Multiple Indicator Cluster Survey
MoH Ministry of Health
MUAC Mid-upper arm circumference
NIMAS National Integrated Micronutrient and Anthropometry Survey of the Kyrgyz Republic
NPW Non-pregnant women (15-49 years)
ppm Parts per million
PSC Children 6-59 months of age
PSU Primary sampling unit
PW Pregnant women
QC Quality control
RBP Retinol-binding-protein
RTK Rapid Test Kit
SAC Children 5-9 years of age
UNICEF United Nations Children’s Fund
US CDC US Centers for Disease Control and Prevention
VAD Vitamin A Deficiency
WAZ Weight-for-age z-score
WHO World Health Organization
WHZ Weight-for-height z-score

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

EXECUTIVE SUMMARY

Introduction
In the Kyrgyz Republic, the overall nutrition situation among children under 5 years of age has improved over the
past two decades. Prevalence of stunting, wasting and underweight has decreased by 30-50 percent between
2006 to 2018. Prior to 2021, data on micronutrient status and anemia were either outdated or entirely missing
for children 6-59 months of age, children 5-9 years of age, adolescent girls, and women of reproductive age.
The limited data available, however, depict a situation of high prevalence of anemia and iron deficiency in
children and women as well as a high prevalence of folate deficiency in women. Furthermore, country data
on the prevalence of other micronutrient deficiencies, such as vitamin D, were entirely lacking. In order to
increase the understanding of the severity of micronutrient deficiencies and help design evidence-based
nutritional intervention programs for nationwide implementation, the Ministry of Health, UNICEF and other
stakeholders have conducted the National Integrated Micronutrient and Anthropometric Survey in the Kyrgyz
Republic (NIMAS 2021).

Aim and objectives

The overall aim of the NIMAS was to obtain updated and reliable information on the current micronutrient and
nutrition situation of several target groups living in the Kyrgyz Republic.

The objectives of the NIMAS included assessing the nutritional and micronutrient status of specific subgroups
of the Kyrgyz population, evaluating infant and young child feeding (IYCF) practices, assessing the relative
importance of selected likely causes of anemia, estimating the consumption of fortified foods and proportion
of fortified and adequately fortified foods.

The target population groups of the NIMAS were children 6-59 months of age (PSC), children 5-9 years of
age (SAC), adolescent girls 10-18 years of age (AG), non-pregnant women of reproductive age 15-49 years
(NPW), and pregnant women (PW). Data was collected from all pregnant women when encountered in selected
households, but their small number precluded stratum-specific conclusions. For the other target groups,
most of the indicators measured were representative at the national level and for each of the 9 survey strata.
Stratification was based on the 7 regions of the Kyrgyz Republic and the two cities of Bishkek and Osh.

Key nutrition and micronutrient indicators were: anemia prevalence in PSC, SAC, AG, NPW and PW; prevalence
of iron deficiency (including iron deficiency anemia) and vitamin A deficiency in PSC, SAC, AG and NPW; vitamin
D deficiency in PSC, AG and NPW; folate deficiency among AG and NPW; and iodine status in AG, NPW and PW.
Other nutrition indicators of interest included prevalence of stunting, wasting, underweight and overweight
among PSC; stunting, underweight, overweight and obesity in SAC and AG, underweight, overweight and
obesity in NPW and acute malnutrition in PW. Further, adequacy and coverage of iodized salt and of iron
fortified wheat flour was assessed.

Design
The NIMAS 2021 was designed as a national cross-sectional survey with 9 geographical strata. The primary
sampling units (PSUs) from the 2018 Multiple Indicator Cluster Survey (MICS) served as the sampling frame for
the NIMAS 2021. A two-stage sampling procedure was used to randomly select households, and subsequently
children, adolescent girls, and women.

In the first stage of sampling, the NIMAS used a sub-sample of the PSUs included in the 2018 MICS. Within
each stratum, the number of MICS PSUs selected for NIMAS 2021 were allocated to urban and rural sub-
strata proportional to the population of each stratum. Selection of PSUs was done using equal probability
simple random sampling. Such proportional sub-stratification increased the precision of stratum-specific
estimates. Due to differences in household size and composition between the oblasts, stratum specific sample
sizes were calculated based on household size and composition reported in the MICS 2018. Thus, different

18
 REPORT- OCTOBER 2022

numbers of PSUs were randomly selected from the MICS PSUs for each stratum: Bishkek: 37; Batken: 22;
Chui: 25; Jalal-Abad: 25; Naryn: 23; Osh: 24; Talas: 20; Issyk Kul: 27; Osh City: 28. This resulted in 231 PSUs
selected for the entire survey sample. The second stage of sampling consisted of random selection with equal
probability of 15 households in each selected PSU. The NIMAS 2021 recruited all PSC, SAC, AG, and PW from
all selected households. However, NPW 19-49 years of age were included from 50% of households, as this
yielded a sufficiently large sample size.

Results
In this executive summary, only national estimates are presented, and Table 1 refers the reader to the
corresponding table in the report for more detailed results.

Table 1. Summary results of the NIMAS 2021

Target group Indicatora Result Tableb

Household
Food insecurity 29.6% Table 11
Iodized salt 98.2%
Table 15
Adequately iodized salt (≥15 ppm) 75.6% c
Iron fortified flour 24.1%
Table 18
Adequately iron fortified flourd
1.7% c
Children 6-59 months of age (unless otherwise indicated)
Ever breastfed (6-23 months) 96.9%
Early initiation of breastfeeding (6-23 months) 91.8%
Exclusive breastfeeding for first two days after birth 77.1%
(6-23 months)e
Introduction of solid foods (6-8 months) 74.5% Table 23
Minimum dietary diversity (6-23 months) 26.2%
Minimum meal frequency (6-23 months) 64.3%
Minimum acceptable diet (6-23 months) 15.3%
Bottle feeding in the past 24h (6-23 months) 50.0%
Stunting 7.0% Table 27
Wasting 0.8% Table 28
Overweight or obese 7.3%
Underweight 0.7% Table 29
Small head circumference 1.3%
Anemia 20.9% Table 30
Iron deficiency 47.0%
Iron deficiency anemia 15.0% Table 30
Vitamin A deficiency 15.0% Table 31
Vitamin D deficiency (subsample) 5.0%
Table 32
Vitamin D deficiency or insufficiency (subsample) 25.4%
Children 5-9 years of age
Meets minimum dietary diversity 70.2% Table 40
Short stature 4.3% Table 42
Thinness 1.4%
Table 43
Overweight or obese 13.8%
Underweight 2.6% Table 44

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Anemia 7.8%
Iron deficiency 29.2% Table 45
Iron deficiency anemia 4.5%
Vitamin A deficiency 16.0% Table 46
Adolescent girls (10-18 years)
Meets minimum dietary diversity 68.6% Table 52
Short stature 2.9% Table 54
Thinness 2.4%
Overweight 10.8%
Table 55
Obese 3.7%
Overweight or obese (combined) 14.5%
Anemia 14.6%
Iron deficiency 46.5% Table 56
Iron deficiency anemia 12.7%
Vitamin A deficiency 7.1% Table 57
Folate deficiency 83.6% Table 58
Vitamin D deficiency (subsample) 8.6%
Table 59
Vitamin D deficiency or insufficiency (subsample) 39.3%
Urinary iodine median (µg/L) 175.1 Table 60
Non-pregnant women (15-49 years)
Meets minimum dietary diversity 69.5% Table 68
Underweight 5.8%
Overweight 27.2%
Table 70
Obese 17.0%
Overweight or obese (combined) 44.3%
Anemia 25.3%
Iron deficiency 55.9% Table 71
Iron deficiency anemia 23.1%
Vitamin A deficiency 4.3% Table 72
Folate deficiency 83.2% Table 73
Vitamin D deficiency (subsample) 15.6%
Table 74
Vitamin D deficiency or insufficiency (subsample) 51.1%
Urinary iodine median (µg/L)
Non-pregnant non-lactating women 167.19 Table 75
Non-pregnant lactating women 134.26 Table 76
Pregnant women
Meets minimum dietary diversity 66.5% Table 83
Undernutrition (low MUAC) 6.9% -
Anemia 49.3% Table 84
Urinary iodine median (µg/L) 180.5 Table 85
a
See text of method section for case definitions.
b
Refer to the table indicated for more detailed analysis of the outcome, including group-specific results by age, region, wealth quintiles
and other analyses.
c
Denominators for “adequately iodized salt” and “adequately iron fortified flour” are all households that provided a sample
d
Adequately fortified: iron EDTA >15ppm; ferrous sulfate, ferrous fumarate >60ppm
e
Exclusive breastfeeding <6 months not included since age range (0-5 months) not part of the NIMAS

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 REPORT- OCTOBER 2022

Discussion
• Household level data shows that food security is a notable problem in the Kyrgyz Republic, particularly
in Issyk Kul, Naryn and Chui, where just about half of the households report to be food insecure and
about every tenth household is severely food insecure. Food insecurity is mainly driven by poverty, which is
reflected in the NIMAS data, as a large proportion of severely food insecure households are in the lowest
wealth quintile.
• Salt was sampled from almost all households and analyzed qualitatively using a rapid test kit and
quantitatively using the iReader device. Quantitative analyses show that about 98% of households use
iodized salt (concentration ≥ 5mg/kg or ≥ 5ppm), 76% use adequately iodized salt (≥ 15 mg/kg or ≥ 15ppm)
and about 23% of the households use inadequately iodized salt. If the higher cut-off set by the Kyrgyz
government (40±15mg iodine/kg or 40ppm±15ppm salt) were applied, only about 31% of the households
use adequately iodized salt.
• Almost all households had flour at home at the time of the NIMAS. More than half of the households
reported using fortified flour (by perception) and about three- quarter of households with flour had flour
in its original package, with nearly ½ of the packages stating that the flour was fortified. Nevertheless,
only one quarter of all samples collected were fortified, and only 2% of samples were adequately fortified.
Moreover, no significant difference in the proportion of fortified flour was observed between flour produced
in the Kyrgyz Republic and imported flour.
• The NIMAS identified 7% of children 6-59 months of age as being stunted, so that stunting can be classified
as a mild public health problem (2.5%- <10%) at the national level according to WHO classification.
However, stunting is considered a problem with medium public health significance for certain sub-groups,
such as children with low birth weight, children living in Batken, and children whose households are of
the lowest wealth quintile, severely food insecure, had no adequate sanitation or no safe drinking water.
Wasting and underweight in children 6-59 months of age living in Kyrgyzstan is rare with a prevalence of
less than 1%. On the other hand, the prevalence of overweight and obesity in children 6-59 months of age
can be classified as a problem with “medium” public health significance. The prevalence of overweight and
obesity steadily increases with increasing age. It affects about 20% of adolescent girls aged 15-18 years,
nearly 45% of non-pregnant women 15-49 years of age and more than 75% of women 45-49 years of age.
• Both anemia and iron deficiency are common in women and children 6-59 months of age in the Kyrgyz
Republic. Anemia is considered a “moderate” public health problem in non-pregnant women and children
6-59 months of age and a severe public health problem in pregnant women according to the criteria
published by the World Health Organization. Anemia is less common in children 5-9 years of age and
adolescent girls, posing a “mild” public health problem. Compared to the micronutrient survey conducted
in 2009, the prevalence in children 6-59 months of age decreased by five percentage points and increased
by three percentage points in non- pregnant women. Iron deficiency has been identified in this survey as
a strong putative risk factor for anemia in all population groups and a large proportion of individuals with
anemia have concurrent iron deficiency. There is some evidence that vitamin A deficiency also contributes
to nutritional anemia in children 5-9 years of age, adolescent girls and non-pregnant women. For children
5-9 years of age anemia was also found to be more prevalent in those with elevated inflammation markers
indicating that anemia of inflammation and chronic disease also contribute to the overall anemia burden,
but most likely to a lower extent than anemia due to iron deficiency.
• Vitamin A deficiency is present in all population groups and poses a mild public health problem in
adolescent girls and non-pregnant women and a moderate public health problem in children. Compared
to the micronutrient survey conducted in 2009, the prevalence in children 6-59 months of age and non-
pregnant women increased by 11 and 4 percentage points, respectively. It is likely that the termination
of the vitamin A supplementation program in 2011 and the discontinuation of the micronutrient powder
program in 2018 led to the substantial increase in vitamin A deficiency prevalence from 2009 to 2021. While
vitamin A status poses a mild to moderate public health problem nationally, the problem can be classified
as severe in certain regions. Specifically, the problem is severe in children 6-59 months of age living in
Bishkek and in children 5-9 years of age living in Chui and Osh City. Moreover, vitamin A deficiency is highly
associated with elevated inflammation markers in children, adolescent girls and women, highlighting the
important role of vitamin A in immune health.
• Folate deficiency is very high (>80%) in Kyrgyz adolescent girls and non-pregnant women. The high
prevalence merits attention, particularly since folate deficiency is the main cause of neural tubes defects
and increases the risk of preterm delivery, infant low birth weight, and fetal growth retardation.

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

• The prevalence of vitamin D deficiency in children 6-59 months of age is 5% and is higher among adolescent
girls and non-pregnant women; 9% and 15% respectively. Similarly, the proportion of individuals with
insufficient vitamin D status is lowest in young children and highest in non-pregnant women. Significant
differences in the vitamin D deficiency or insufficiency prevalence were detected in children 6-59 months of
age: About half of the children 6-11 months of age and half of the children living in the wealthiest households
have suboptimal vitamin D status. Though vitamin D deficiency prevalence in the Kyrgyz Republic can be
considered low, the high prevalence of young children with suboptimal status merit attention due to the
important role of vitamin D in the processes of cell proliferation, differentiation, and maturation.
• Nationally, the median urinary iodine concentration in adolescent girls, non-pregnant (lactating and non-
lactating) and pregnant women indicate adequate iodine status in all population groups. Though significant
differences were observed for some sub-groups, only pregnant women residing in households in the
highest wealth quintile and non-pregnant lactating women living in severely food insecure households,
and those living in households using salt that was not iodized were identified with inadequate iodine status.
However, the number of non-pregnant lactating women in the subgroup analyses is small and results
will have to be interpreted with caution. Of note, pregnant women 15-19 years of age and non-pregnant
adolescent girls living in Talas have a median urinary iodine concentration just below the threshold for
being classified with excess iodine intake.

Strengths and limitations

• The NIMAS yields national and region-specific prevalence estimates for a variety of micronutrient
biomarkers in children 6-59 months of age, children 5-9 years of age, adolescent girls 10-18 years of
age, non-pregnant women 15-49 years of age and pregnant women, which will guide future decisions of
national stakeholders and inform national nutrition programs.
• The NIMAS yielded satisfactory response rates for households (89%), children 5-9 years of age (78% for
venous blood sample), adolescent girls and non-pregnant women (77% for venous blood sample). However,
a relatively high refusal rate for blood sampling among children 6-59 months of age and some technical
difficulties to successfully collect venous blood samples in children 6-59 months of age were experienced,
which resulted in a slightly smaller number of children with blood sample (72%) than a priori estimated
and thus slightly lower precision for stratum- and age-specific prevalence estimates than calculated a
priori.
• The NIMAS included children 5-9 years of age and adolescent girls 10-18 years old in addition to children
6-59 months of age and non-pregnant and pregnant women, enabling for the first time to comprehensively
assess nutritional status in those age groups. One challenge faced during the interpretation of the results
was that for several blood biomarkers, no established thresholds exist for children 5-9 years of age
and adolescent girls, thus thresholds from the literature were used, where available or, when lacking,
thresholds from different population groups were applied.
• Quantitative analysis of salt iodine content allowed for a more accurate estimation of household coverage
with adequately iodized salt than previous estimations. Moreover, it was possible to estimate the proportion
of households using inadequately iodized salt.
• Similar to the 2009 micronutrient survey, the NIMAS collected venous blood samples, which removed
potential pre-analytical biases, which can occur with capillary sampling, such as the potential of sample
dilution from interstitial fluid. Moreover, both surveys measured hemoglobin concentrations on a portable
device (HemoCue 301). The anemia prevalence rates between the two surveys are comparable and
importantly, are much lower than reported in the Demographic and Health Survey (DHS) 2012. The DHS
used capillary blood to measure hemoglobin on a different portable hemoglobinometer (HemoCue 201+).
Recent research indicates that hemoglobin measurements from capillary blood samples and the HemoCue
201+ yield reduced hemoglobin concentrations and thus, increased anemia prevalence. On the other hand,
there is some evidence that the HemoCue 301 yield slightly increased hemoglobin concentration and thus a
lower anemia prevalence. To validate the hemoglobin results obtained from the HemoCue 301, the NIMAS
measured hemoglobin on a complete blood counter in a sub-sample of children 6-59 months of age,
children 5-9 years of age, adolescent girls and non-pregnant women. The mean hemoglobin concentration
measured by the complete blood count (CBC) is 4g/L (~3%) lower than the concentration obtained by the
HemoCue 301 across all population groups. Hence, though the actual prevalence of anemia might be
slightly higher than estimated, classification of public health significance of anaemia remains the same.

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 REPORT- OCTOBER 2022

Recommendations
• Reduce household food insecurity and poverty
The proportion of households living under the poverty line is high and is expected to further increase mainly
due to the crisis in Ukraine and the ongoing pandemic affecting remittances, food prices, job opportunities,
and causing a continued cooling of the economy. Existing programs must be adapted to the current situation
in order to counteract a further increase in poverty and, if possible, to reduce the number of people living
below the poverty line. In addition, creation of new programs to fight poverty could be considered.
• Amend the salt iodization law
The NIMAS generally found that adolescent girls, non-pregnant women, and pregnant women have
adequate iodine status, indicating that the salt iodization programme is functioning well. Sub-group
analyses, however, reveal a relatively large variation in urinary iodine, with some population groups at
the edge of excess iodine. To reduce that variation, stakeholders in the Kyrgyz Republic should consider
aligning the salt iodization standards, currently set at 40ppm ± 15ppm, with the international cut-off of
15ppm. This change in the salt iodization standards should be accompanied by the strengthening of the
compliance monitoring system used to enforce salt iodization at the level of salt production, importation,
and distribution. Moreover, since the iodine status of the population is at the high end of adequacy, programs
designed to reduce salt intake would not have a serious effect on iodine status.
• Strengthen wheat flour fortification
Only one third of households use fortified flour and only 2% of households use flour that is fortified
according to national standards1, with non-significant differences between the locally produced and the
imported flour. Therefore, adherence to fortification standards of locally-produced wheat flour should be
strengthened at the level of production and distribution, and monitoring activities should be extended to
ensure that imported flour meets the Kyrgyz Republic’s national standards. These actions can be expected
to increase coverage of adequately fortified wheat flour and to provide additional micronutrients. If both are
implemented, reductions of anemia, iron and folate deficiency are plausible. Moreover, adding vitamin D to
the fortification program might then be a viable strategy to combat vitamin D deficiency.
• Reduce the prevalence of overweight and obesity
Overweight and obesity is a public health problem with medium relevance in young children and a
serious public health concern in women, particularly in older women and should be addressed through
governmental policies and programs. Programs targeted to pregnant and lactating women are an entry
point for reducing overweight and obesity in young children as well as adult women. It is thus recommended
that antenatal and postnatal care be expanded to include behaviour change messages and counselling for
mothers. Further, it is advisable to ideally instil appropriate eating behaviours early in life, since such
changes are often more easily induced in younger people. As such, schools could provide the platform to
deliver messages about good nutrition and provide nutrition education to children 5-9 years of age and
adolescent girls.
• Strengthen other strategies to tackle micronutrient deficiencies
To increase the vitamin A stores in the overall population, the implementation of a vitamin A fortification program
could be considered. Because food fortification of staples may not be the most appropriate approach to reach
young children 6-23 months of age, since their food intake is limited compared against their micronutrient
need, programs to provide micronutrient powders may be envisioned to tackle iron and vitamin A deficiencies
in young children. Moreover, campaigns that raise the awareness of folate, vitamin A and iron deficiencies and
promote the consumption of nutrient rich foods should be implemented. This type of intervention could include
promoting local food products rich in micronutrients. Lastly, supplementation is a viable, though more costly,
alternative to fortification to address micronutrient deficiencies. Overall, vitamin and mineral supplement
consumption is low in women and children. It is therefore recommended that the Kyrgyz Republic’s health
system promote and expand the distribution of these supplements to achieve a high level of coverage and
consumer compliance. General awareness campaigns can also be considered but should only be conducted
when distribution channels are in place guaranteeing access to supplements. To increase the coverage of iron
and folic acid supplement consumption pregnant women can be targeted at their prenatal and postnatal care
visits. Vitamin A supplementation could be linked with vaccination programs in order to achieve a high vitamin
A supplementation coverage in children.

1
The national wheat flour fortification standards of the Kyrgyz Republic state that premium and first grade flours should be fortified at
the following levels:
• Iron: Locally produced flour: iron EDTA ≥15ppm; Imported flour: ferrous sulfate or ferrous fumarate ≥60ppm)
• B-Vitamins: B1 (≥2.0 ppm); B2 (≥3.0 ppm), B3 (≥10.0 ppm), B9/folic acid (≥1.0 ppm), B12 (≥0.008 ppm)
• Zinc: ≥30.0 ppm

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

1. INTRODUCTION

1.1. Country overview

The Kyrgyz Republic is a landlocked country bordering Kazakhstan, Uzbekistan, Tajikistan and China, with
a population of approximately 6.9 million[1]. After independence from the former Soviet Union in 1991, the
economic situation in the Kyrgyz Republic deteriorated – with the gross domestic product (GDP) decreasing
by 45 percent from 1991 to 1995 [2]. In the first decade of the 21st century, the country experienced repeated
crises: the revolution of 2005; extreme winters in 2008 and 2009 followed by drought and surges in food and fuel
prices; the revolution of 2010; the ethnic conflict in 2010 and the revolution in 2020 [3]. Since 2010 the economy
has rebounded and the GDP was estimated around 8.5 billion USD in 2019 compared to about 4.8 billion in 2010
[4]. Due to the COVID pandemic the GDP fell by almost 9% in 2020 but recovered in 2021, reaching almost the
same level as before the crises [5].

As of 2021, the Kyrgyz Republic ranked 118 out of 189 countries evaluated in the Human Development Index (HDI).
While in 2018 20% of the population was considered ‘poor’ according to national standards and just about 0.6 %
lived under the global absolute poverty line of 2 standardized USD a day[6], the situation has worsened mainly due
to the global food crises and the COVID 19 pandemic with poverty increasing to 33% in 2021 [7].

1.2. Nutritional situation of the Kyrgyz population

Due to the Kyrgyz Republic’s geomorphological diversity, with high mountain ranges and deep gorges, it is not
surprising that economic development varies across the country and between urban and rural areas. Along
with economic disparities, food security assessments have shown that rural areas are both poorer and less
food secure than urban areas. The limited household purchasing power also affects the quality and diversity
of the diet in certain regions.

Reducing undernutrition, including micronutrient deficiencies, contributes to achieving progress in human

and economic development. Women of reproductive age, particularly during pregnancy and lactation, exhibit
increased nutrient needs and are therefore a vulnerable population group. Additionally, because of the critical
link between maternal and child nutrition, public health efforts have turned to ensuring adequate child nutrition
during the first “1,000 days” — from conception to a child’s second birthday. More recently, the importance of
a continuum of adequate nutrition has been re-expanded to the 8000 days window, thus including school-
children and adolescents [8].

In the Kyrgyz Republic, the overall nutrition situation among children 6-59 months of age (children under five)
has improved over the past two decades. Data on stunting, wasting and underweight prevalence demonstrates
(Table 2) that 2006-2018, the prevalence of these three forms of malnutrition decreased by 30%-50% [9–11].

Data on micronutrient status and anemia is either outdated or entirely missing for children 6-59 months of age,
children 5-9 years of age, adolescent girls, and women of reproductive age.

The available data depict a situation of high prevalence of anemia and iron deficiency (ID). In children 6-59
months of age, the data shows that anemia prevalence increased from 26% in 2009 [12] to 43% in 2012 [13];
among women of reproductive age the prevalence increased from 23% to 35% in the same time period [12,13].
However, such a large difference over a short period of time can unlikely be explained by a drastically deteriorating
situation. More likely, other factors, such as seasonality or methodological differences contributed to this
difference, such as the use of different hemoglobinometers (HemoCue 201 vs. HemoCue 301). Depending on
the prevalence used, anemia would be classified as a moderate or severe public health problem according to
WHO [14]. A survey in 2013 among children 6-29 months of age found that 33% of children were anemic. This
is comparable to 2009, when anemia prevalence among children aged 6- 35 months ranged from 30% to 42%.
The 2009 national survey on the nutritional status of children and their mothers [12] found that almost 50% of
women of reproductive age had folate deficiency and about 50% of the children 6-59 months of age and women

24
 REPORT- OCTOBER 2022

of reproductive age had ID. On the other hand, the vitamin A deficiency prevalence was relatively low in both
children and women.

Data on the prevalence of other micronutrient deficiencies, such as vitamin D, zinc or vitamin B12 are lacking
in the Kyrgyz Republic.

Data on anemia and micronutrient status in children 5-9 years of age and adolescent girls in the Kyrgyz
Republic is scarce and therefore these two population groups are not shown in Table 2 below. However, the
DHS 2012 reported that 34.5% of women aged 15-18 years were anemic [13], while for 8-10 year old school-
age children, only data on urinary iodine concentration (UIC) were generated in 2007, indicating a median UIC
of 114 µg/L [15].

In recent years, the double burden of malnutrition – where undernutrition (micronutrient deficiencies, stunting,
wasting and underweight) and overweight and obesity or nutrition related non-communicable diseases (e.g.
diabetes mellitus type 2) occur concurrently - has become more common, particularly among women living in
urban areas [16]. As per 2012 data, more than one-third of women of reproductive age in the Kyrgyz Republic
were overweight or obese [13], with an upward trend, while child overweight was about 7% in 2014 [10] and
2018 [11]. Meanwhile, stunting prevalence was estimated to be about 12% and wasting and underweight each
about 2% in children 6-59 months of age in 2018 [11].

Table 2. Prevalence estimates for nutrition-relevant data in the recent past in the Kyrgyz Republic.

MICS IHS NNS DHS MICS MICS Other surveys

Nutrition indicator
2006[6] 2008 2009[9] 2012[10] 2014[7] 2018[8] or studies
Household
Iodized salt (%) 76a - 97a 93a 92a 40 [12]
Children 6-59 months
Anemia (%) - - 26 43 - - 33 [14]b
Iron deficiency (%) - - 50 - - - 35 [14]b
Iron deficiency anemia (%) - - 18 - - - 24 [14]b
Vit A deficiency (%) - - 4.2 - - - 16 [14]b
Stuntingc (<-2SD) (%) 17 30 23 18 13 12 -
Wastingc (<-2SD) (%) 3.9 - 1.3 2.7 2.8 2.0 -
Underweightc 3.7 4.1 4.7 3.4 2.8 1.8 -
(<-2SD) (%)
Overweightc (> +2SD WHZ) 5.8 - 4.5 8.5 7.0 6.9 -
(%)
Women 15-49 years
Anemia (%) - - 23 35 - - -
Iron deficiency (%) - - 51 - - - 59 [15]d
Iron deficiency anemia (%) - - 20 - - - -
Vit A deficiency (%) - - 0.6 - - - -
Folate deficiency (%) - - 49 - - - -
Underweight - - 6.5 7.3 - - -
(BMI <18.5, %)
Overweight/obese - - 32 36 - - -
(BMI>25, %)
Median urinary iodine conc. - - - - - - 111 [12]e
(µg/L)
a
Results determined by rapid iodine test kits;
b
Children 6-<30 months;
c
Children 0-59 months;
d
Women living in Talas Oblast with a child 6-24 months old only;
e
Survey included pregnant women only, cut-off used to define iodine deficiency: 150 µg/L

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

1.3. Programs to combat micronutrient deficiencies in the Kyrgyz

Republic
The Kyrgyz Republic currently has two main micronutrient deficiency control programs in place: salt iodization
and wheat flour fortification with iron, zinc, niacin, riboflavin, thiamine, and folic acid2. The first national salt
iodization program began in 1994 [19]. It culminated in the law enacted by the Kyrgyz Government in 2001 that
mandated all imported and locally-produced edible salt be fortified using potassium iodate (40±15mg iodine/kg
salt) [13,15,20]. Salt iodization has made notable progress since 2000, and the household coverage of iodized
salt increased from 76% in 2006 to 97% in 2012 and has remained above 90% ever since as reported by DHS
and MICS [9–11,13]; of note though, most testing was conducted using rapid test kits that have been shown to
inaccurately identify the level of iodine concentration in salt [21]. In addition to consumption of iodized table
salt, it has been reported that iodized salt is used by food companies, including bakeries; thus, the population
is likely consuming both iodized table salt and iodized salt through processed foods, such as bread [19]. The
only national estimate of iodine status, which was done in 2007, indicated iodine sufficiency among children
8-10 years of age, but insufficiency among pregnant women. Contradicting the results from DHS and MICS,
this 2007 survey found that less than 40% of the households consumed adequately iodized salt, as measured
by iodometric titration [15].

Regarding wheat flour fortification, UNICEF began supporting millers with equipment and premix in 1998, and
this effort was followed by a Central Asian regional fortification program in 2002-2007, supported by the Asian
Development Bank (ADB). Specifically, the ADB project helped establish a regional premix standard, the KAP
Komplex #1, which has been used by multiple countries in Central Asia. The Kyrgyz Republic followed the KAP
Komplex #1 standard until 2009, when it changed the iron compound from electrolytic iron to NaFeEDTA. KAP-
complex #1 ensures that the quality of flour fortified with iron, zinc, niacin, riboflavin, thiamine, and folic acid,
is maintained [22]. In 2017 UNICEF and partners conducted a monitoring survey on the availability of fortified
flour. They found that according to the flour package label about half of the surveyed households consumed
fortified flour.

Children were also provided with vitamin supplements. National and regional nutrition surveys conducted
between 2008 and 2010 have shown that approximately two-thirds of Kyrgyz children 6-59 months of age are
given vitamin D supplements by their care-givers [12,17,23]. Approximately 57% and 30% of children nationally
receive multi-vitamin and fish oil supplements, respectively [12].

Micronutrient supplementation of children 6-59 months of age and post-partum women began in 2004 [24].
Coverage of vitamin A supplementation of children increased rapidly; the Kyrgyz Republic’s 2009 national
nutrition survey found that nearly 95% of children ever received a vitamin A supplement, with 80% receiving the
supplement in the past six months (36% of mothers received a vitamin A supplement within 2 months after their
last pregnancy). Due to low vitamin A deficiency prevalence in children in 2009 and the scale-up of multi-nutrient
supplements in 2011, the Kyrgyz Ministry of Health replaced vitamin A supplementation with micronutrient
powders [13]. The Gulazyk programme was fully maintained by the Government and development partners at
national level until April 2014. After this time disruptions began to emerge in the provision of Gulazyk. Although
integration of Gulazyk into infant and young child feeding practices in communities was considered effective,
the procurement platforms required to sustain the practice were challenging. Procurement difficulties were
further exacerbated by competing priorities related to high disease burden and limited capacity and resources
at the national and local levels. Despite the positive impact, 2018, the MoH ceased to procure Gulazyk, asserting
that Gulazyk was registered as a biologically active supplement and thus not considered part of the essential
medicines list.

The Gulazyk programme offers valuable lessons on outcomes. There is a clear need to place food security
and nutrition firmly within a health system strengthening approach, supported by community- and home-
based information and communication approaches. Nevertheless, compromise should be reached in the best
interests of children in the Kyrgyz Republic. Safe spaces for these dialogues and critical thinking could be
fostered to address malnutrition and dietary deficiencies among mothers and children.

2
The national wheat flour fortification standards of the Kyrgyz Republic state that premium and first grade flours should be fortified at
the following levels:
• Iron: Locally produced flour: iron EDTA ≥15ppm; Imported flour: ferrous sulfate or ferrous fumarate ≥60ppm)
• B-Vitamins: B1 (≥2.0 ppm); B2 (≥3.0 ppm), B3 (≥10.0 ppm), B9/folic acid (≥1.0 ppm), B12 (≥0.008 ppm)
• Zinc: ≥30.0 ppm

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1.4. Rationale for the survey

While the Kyrgyz Republic has some data available on the nutritional and micronutrient status of young children
and women, there is no recent comprehensive assessment of nutritional status measuring both micro- and
macro-nutritional indicators in any of the target groups.

As an integral element of the national Food Security and Nutrition Programme 2019-2023 and the 2030
Government Health Programme, the NIMAS 2021 was conducted to both increase the understanding of the
severity of micronutrient deficiencies and help design evidence-based nutritional intervention programs for
nationwide implementation. The NIMAS also establishes a baseline against which to measure the future
progress of various national nutrition programs. Furthermore, by including multiple target groups, the data
produced by NIMAS can be used by multiple governmental agencies to design nutrition programs. Lastly, the
survey simultaneously collected data on under-nutrition and over-nutrition to provide information about the
extent of the double burden of malnutrition.

1.5. Objectives
The NIMAS 2021 was nationwide in scope and collected data from 6 target groups: 1) households, 2) children
aged 6-59 months (PSC), 3) children aged 5-9 years (SAC), 4) adolescent girls 10-18 years old (AG), 5) non-
pregnant women of child-bearing age, 15-49 years of age (NPW), and 6) pregnant women of any age (PW). For
more details on the survey population see chapter 2.3. Indicators collected varied by population groups and
are detailed below.

Primary and secondary objectives were proposed initially by the Ministry of Health, UNICEF and other national
stakeholders. They were subsequently revised based on the input of GroundWork and the technical committee
consisting of national (e.g. Ministry of Health the Kyrgyz Republic, National Statistical Committee, Republican
Health Promotion Center) and international (e.g. UNICEF, WFP, USAID, Mercy Corps) stakeholders.

1.5.1. Primary objectives

1. To measure the prevalence and severity of anemia in PSC, SAC, AG, NPW, and PW by measuring the
hemoglobin concentration.

2. To measure the prevalence of ID in PSC, SAC, AG, and NPW using plasma ferritin concentration. Plasma
ferritin was adjusted for the presence of inflammation as indicated by elevated levels of C-reactive protein
(CRP) and alpha-1-acid glycoprotein (AGP).

3. To measure the prevalence of vitamin A deficiency in PSC, SAC, AG and NPW using retinol binding protein
(RBP). For PSC, RBP was adjusted for the presence of inflammation as indicated by elevated levels of
C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP).

4. To assess the prevalence of vitamin D deficiency in a sub-sample of PSC, AG and NPW by measuring
plasma 25[OH]D.

5. To measure the prevalence of folate deficiency among AG and NPW using plasma folate.

6. To assess iodine status among AG, NPW and PW by measuring urinary iodine concentration.

7. To measure the prevalence of acute malnutrition (wasting) using weight-for-height z-scores, chronic
malnutrition (stunting) using height-for-age z-scores, underweight using weight-for-age z-scores,
overweight and obesity using weight-for-height z-scores and brain growth using head circumference-for-
age z-scores in PSC.

8. To measure the prevalence of chronic malnutrition (stunting) in SAC by calculating height-for-age z-scores;
in the same age group, measure the prevalence of underweight calculated using BMI-for-age z-scores,
overweight and obesity by calculating the BMI-for-age z-score.

9. To measure the prevalence of chronic malnutrition (stunting) in AG by calculating height-for-age z-scores;

in the same age group, measure the prevalence of underweight, overweight and obesity calculated using
BMI-for-age z-scores.

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10. To measure the prevalence of chronic energy deficiency and overweight and obesity in NPW by calculating
BMI or BMI-for-age z-score.

11. To measure the prevalence of acute undernutrition in pregnant women by measuring mid-upper arm
circumference (MUAC).

12. To measure the household coverage of (adequately) iodized salt.

13. To measure the household coverage of (adequately) fortified wheat flour in a sub-sample of households.

1.5.2. Secondary objectives

Other variables which may influence various types of malnutrition or play a potentially causative role were also
assessed. Such additional variables included socio-economic status, household food security, individual food
consumption patterns, infant and young child feeding and breastfeeding practices, intake of micronutrient
supplements, and others. Additionally, a short module on household purchases of potentially fortified salt and
wheat flour was included to estimate consumption of these.

Further, vitamin A deficiency results were also obtained for NPW and AG from the laboratory at no additional
costs as the vitamin A biomarker is measured as part of a set of 5 biomarkers including iron, vitamin A and
inflammation markers.

Given the current pandemic situation, the survey also served as a vehicle to collect updated information about
the context of COVID-19 in the Kyrgyz Republic.

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2. METHODOLOGY

2.1. Geographic scope and basic sampling frame

The sampling universe consisted of all households residing in the Kyrgyz Republic at the time of survey data
collection, regardless of nationality and/or ethnicity. To make separate estimates of each outcome for the
Kyrgyz Republic’s administrative zones, nine explicit strata were created representing the 7 regions and the
two cities of Bishkek and Osh City. Due to differences in household size and composition between the oblasts
and the cities of Bishkek and Osh, stratum specific sample sizes have been calculated based on household size
and composition reported in the MICS 2018. Thus, different numbers of PSUs were randomly selected for each
stratum to achieve the desired sample size. The NIMAS included the following numbers of PSU in the different
strata: Bishkek: 37; Batken: 22; Chui: 25; Jalal-Abad: 25; Naryn: 23; Osh: 24; Talas: 20; Issyk Kul: 27; Osh City:
28 (see Figure 1).

In each PSU, 15 households were selected. Separate samples were selected for each stratum and produced
stratum-specific and, when combined and appropriately statistically weighted, nationally representative
estimates. Within each stratum, PSUs were allocated to urban and rural sub-strata proportional to the
population of that stratum. Such proportional sub-stratification increased the precision of stratum-specific
estimates. The approach for the NIMAS 2021 enabled the calculation of sufficiently precise estimates for each
stratum to make stratum-specific conclusions and recommendations, except for pregnant women, where only
national estimates were obtained with reasonable precision.

Bishkek city

Chui oblast
Talas oblast
Issyk-Kul oblast

Jalal-Abad oblast Naryn oblast

Osh city

Osh oblast NIMAS PSUs

Batken oblast Road network
Major water bodies
Oblast boundaries

Figure 1. Kyrgyz Republic’s administrative zones and PSUs selected for NIMAS

2.2. Sampling approach and sample size determination

The NIMAS 2021 was a cross-sectional stratified survey based on a probability sample large enough to produce
stratum-specific estimates for priority nutrition indicators. These estimates were expected to yield acceptable
precision for decision makers to draw conclusions and make programme decisions.

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For the calculation of the sample size, the key indicator used was anemia prevalence among non-pregnant
women and children 6-59 months of age as anemia in these groups was one of the key indicators of the NIMAS.

The Fisher’s formula for estimating the minimum sample size for prevalence descriptive studies was used as follows:

Z 2α / 2 P (1 − P ) 100
n= 2
* DEFF *
d RR
Where:

n = minimum sample size, expressed as number of units of analysis,

Zα/2 = Z value corresponding to 95% confidence intervals

P = the assumed prevalence

d = the allowable sampling error, or ½ the desired confidence interval

DEFF = design effect

RR = response rate expressed as a decimal

The calculated number of children and women needed for the survey sample had to be converted to the number
of households to select, which was done by accounting for the average household size and the proportion of
the general population made up of the specific target group in each of the different strata using the MICS 2018
data. In total, 3465 households were calculated to be selected to ensure sufficient sample size of households,
children, and non-pregnant women. For PSC, the selection of 3465 households should have resulted in
the enrolment of approximately 1615 PSC for the entire survey sample, about 1453 of whom with biologic
specimens. The selection of 3465 households should have resulted in the enrolment of approximately 1291
SAC for the entire survey sample, about 1097 of whom with biologic specimens collected. Further, about 1313
NPW should have been eligible, 1116 of whom with biologic specimens collected. Young women aged 15-18
years belong to two target groups: NPW and AG. Thus, for the target group of AG only girls aged 10-14 years
were to be additionally recruited. The selection of 3465 households should have resulted in the recruitment of
about 927 AG (10-18 years), about 788 with a blood sample.

2.3. Study populations

The study participants were selected from the randomly selected households located in the selected PSUs.
Table 3 lists the inclusion criteria for enrolment into the survey, disaggregated by target population group.
There were no specific exclusion criteria other than the negation of the inclusion criteria. Importantly, Table 3
defines AG 10-14 years of age and NPW 19-49 years of age as target groups since females 15-18 year of age
were included as part of the AG and NPW groups and are therefore listed separately (AG/NPW group in Table 2
below). However, during data analysis, the 15-18 years old females were attributed to both AG and NPW, such
that the AG group includes females from 10-18 years, while the NPW group is composed of females 15-49
years of age.

Table 3. Inclusion criteria by targeted population group

Target population Inclusion criteria

Household • Household head or spouse or other adult household member gives oral consent
for survey data collection
• Members currently reside in the Kyrgyz Republic regardless of nationality and/
or ethnicity.
PSC • Age between 6-59 months of age at the time of survey data collection
• Considered a household member by adults living in the household
• Mother or caretaker gives written consent for interview and collection of
biologic specimens

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SAC • Age 5-9 yearsat the time of survey data collection

• Considered a household member by adults living in the household
• Mother or caretaker gives written consent for interview and collection of
biologic specimens
AG • Age 10-14 yearsat the time of survey data collection
• Considered a household member by adults living in the household
• Oral assent obtained from participating adolescent girl
• Mother or caretaker gives written consent for interview and collection of
biologic specimens
AG/ NPW • Age 15-18 years at the time of survey data collection
• Currently non-pregnant by self-report
• Gives written consent for survey data collection; if <18 years, mother or
caretaker gives written consent for interview and collection of biologic
specimens if AG/ NPW aged <18 years.
• Considered a household member by other adults living in the household
NPW • Age 19-49 years at the time of survey data collection
• Currently non-pregnant by self-report
• Gives written consent for survey data collection
• Considered a household member by other adults living in the household
PW • Currently pregnant by self-report
• Gives written consent for survey data collection
• Considered a household member by other adults living in the household

2.4. Ethical considerations

In order to ensure that the survey follows principles to protect respondents and prevent unnecessary risks
to survey them, ethical approval for the study was obtained from the Scientific and Production Association
for Preventive Medicine of Ministry of Health, Kyrgyz Republic (see appendix 8.9 for approval letter) and also
endorsed by Bioethics Committee of the Ministry of Health (see appendix 8.11 for endorsement letter), Kyrgyz
Republic. In addition, the protocol was also reviewed by a UNICEF-appointed external Institutional Review
Board for quality assurance. The survey protocol was registered with the Open Science Framework study
registry (https://osf.io/8upnd/).

The survey was conducted in line with the UNICEF procedures for ethical standards in research, evaluation,
data collection and analysis [25] and follows the UNICEF ethical reporting guidelines [26]. Further, the survey
respected the UNICEF Child Protection Code, and utmost care was taken that no human rights were violated
and the survey complied with all principles of the international human rights framework [27].

For household interviews, oral consent was sought from the household head or in his/her absence from another
adult household member. The selected women and child caregivers were asked to provide written informed
consent (see appendix 8.10 for information sheet and consent form) for themselves and their participating
children.

2.5. Field work and data collection

2.5.1. Mapping and listing

Prior to data collection, all households located in the selected PSU were listed in order to create a complete
and updated list of households for all selected PSUs. This list served as a sampling frame for the final selection
of households included in the NIMAS 2021 sample.

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A local research agency was hired to provide teams of specialists for listing and mapping. The research agency,
in consultation with an international expert, created 9 teams to work in the 9 different strata. The teams
were trained by the international expert. The listing was conducted in August/ September 2021. During the
household listing operation, each selected PSU was visited to:

a. Update the existing map of the MICS 2018. Both a location map of the PSU as well as a sketch map of the
dwellings in the PSU were drawn.

b. Record an electronic description of location of every dwelling together with the names of the heads of the
households found in the dwelling.

2.5.2. Training of survey teams and field testing

Prior to data collection, team members were thoroughly trained, and all survey instruments were pre-tested
during the training. The training consisted of classroom instruction and practice, and of field testing of all
survey procedures.

Deputy heads of regional health departments were nominated by MoH as regional coordinators to help with
administrative issues and all of them were invited to a one-day orientation workshop. During this workshop,
regional coordinators were informed on survey goals and objectives, on survey protocol and tasks to ensure
support of field work data collection.

Survey staff also received extensive classroom training on each questionnaire, whereby interviewers and
team leaders discussed each question, practiced reading the questions, and role-played interviews in local
languages. In addition, instructions were provided on how to record, save, and upload data on the tablet
computers (Galaxy, Samsung™) and the data entry software (KoboToolbox) used in the survey.

As part of classroom training, anthropometrists and phlebotomists were trained on anthropometric and blood
collection techniques. A standardization exercise was conducted for the survey anthropometrists, whereby
an anthropometrist, assisted by a phlebotomist, measured and recorded the length or height of 10 children,
and their results were checked for precision as well as for accuracy when compared with instructor’s “gold
standard” measurements. Blood collection procedures were practiced, including training on labelling of
samples, processing of samples, labelling of aliquots, pipetting procedures, and maintenance of the cold chain
when transporting blood and urine specimens.

Following classroom training, two days of field testing was undertaken in four PSUs in the vicinity of Bishkek
that were not included in the survey sample. The teams conducted the community sensitization, interviewing
anthropometry, and phlebotomy. Specimens were transported to the laboratory in Bishkek for training
(processing, labelling, storage) of all laboratory technicians from the different regions.

Approximately 20% more field workers than required were enlisted for the training to ensure that all survey
staff ultimately hired could successfully implement the survey procedures. To assess their understanding
of field procedures, a written exam containing questions about various survey procedures was given to all
survey staff towards the end of the training. The results of this exam, the results of the anthropometry
standardization exercise, and observations from the survey trainers were used to a) identify the best-
performing team members and appoint a team leader for each team, and b) identify survey workers that
could not adequately understand and implement the survey procedures. These individuals were released
and were not included for the field work.

2.5.3. Community mobilization and sensitization

During the planning phase of the survey the Ministry of Health issued a comprehensive Order/ Prikaz on
the survey implementation, including organization and coordination of activities, collaboration of regional
coordinators, national institutions, health organizations and other national stakeholders. Upon selection of
PSUs, the Ministry of Health contacted the respective regional health authorities about the selected clusters
in writing to request their support with the NIMAS 2021. At the start of the fieldwork, each survey team was
provided with a copy of an order (see appendix 8.11) from the Ministry of Health. Upon arrival of a team in a
PSU, the team met with the relevant authorities to inform them about the work and also to seek their support.
In most cases, teams met with the head of the local health facility to notify them that the NIMAS 2021 would

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be conducted in their area and to request their support. A press-conference was held, and a number of TV and
radio segments broadcast for sensitization purposes.

2.5.4. Field work: Interviews

Data collection in the 231 PSUs was conducted between 21st September and 16th November 2021.

Each of the 9 teams comprised one team leader, three interviewers, one phlebotomist, one anthropometrist
and one driver. The members of each team are listed in appendix 8.12. Each team was assigned to one of the
7 regions, Bishkek and Osh City and was responsible for data collection in all randomly selected households
in the selected PSUs. All reasonable attempts were made to recruit selected households. At least two repeat
visits were made before dismissing a household as non-responding.

For data collection at the household level, tablet computers were used for direct data entry using Kobo
toolbox. Skip patterns were built into the electronic questionnaires, which sped up interviewing as well as
minimized erroneous entries. Interviewers administered the household questionnaire first, followed by the
child and adolescent girl/woman questionnaires if the household had eligible children and/or adolescent
girls/women. During the household interview, a household roster was completed. Household and individual
questionnaires were available in English, Kyrgyz and Russian. Interviews were conducted in the interviewee’s
preferred language. All questionnaires are provided in appendix 8.13. For the translated versions, the English
questionnaires were translated into Kyrgyz and Russian, and back-translated by a separate translator.
Discrepancies were discussed and harmonized; lastly, during training and field testing, any remaining issues
were corrected in all versions of the questionnaires.

Where available, standard questionnaire modules were used, e.g. for infant and young child feeding questions,
including the 24-hour recall module [28]. To help the respondents recalling food products, interviewers used a
picture catalogue of commonly used food products, e.g. infant cereals, fortified foods, vitamin A supplements,
etc. Similarly, for the women’s questionnaire, the 24-hour recall module was adapted from existing tools [29].

Salt specimens (approx. 100g) were collected in each recruited households and flour samples (approx. 50g) in
every 4th household by the interviewers after completion of the household interview. For selected adolescent
girls, women and children, interviewers prepared and labelled a biological form (see appendix 8.13) and
directed those participants (or their mothers) to a central location in the PSU where the anthropometrist and
phlebotomist were stationed.

2.5.5. Field work: Anthropometry and phlebotomy

First, weight measurements from selected children, adolescent girls and non-pregnant women were taken
using standard methods [30] on a SECA scale (UNICEF, # S0141021). For children who could not stand by
themselves, the mother or caregiver was first measured alone, then together with the child, so that the child’s
weight was obtained by automatic subtraction using the scale’s tare function. The scales were calibrated
every morning using a 5kg calibration weight and results were entered into a scale calibration monitoring
spreadsheet. Scales were replaced if deviation from target was >0.1kg. Children’s height or length was
measured by using a standard wooden height board (UNICEF, #S0114540). For adolescent girls and non-
pregnant women, height was measured using the same standard wooden height board. For pregnant women,
only their MUAC was measured to assess their nutritional status, since weight measurements are not providing
useful anthropometric information during pregnancy. Head circumference was measured in children 6-59
months of age. Each anthropometric measurement was carried out twice in order to ensure a high quality. A
third measurement was conducted in case the first two measurements were too far apart (>0.1g or >0.5cm).

For adolescent girls and non-pregnant women, blood was collected via venipuncture into 6 ml plasma EDTA
tubes. For children (6-59 months and 5-9 years) blood was collected via venipuncture into 4 ml plasma EDTA
tubes. Using a Haemodiff device, a small amount of blood was extracted from the tubes onto a weighing boat
to assess hemoglobin concentration using a portable hemoglobinometer (HemoCue® 301). Remaining whole
blood was placed in a cool box containing cold packs to ensure they were stored cold but not frozen at ~4°C and
in the dark until further processing later the same day. Temperature in the cold boxes was monitored using
thermometers. For pregnant women, blood was collected from a fingerstick for hemoglobin measurement
only. The second drop of blood was used for the hemoglobin measurement.

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A spot urine sample was collected from each selected adolescent girl and woman. A labelled urine beaker was
given to the woman, and she was instructed to bring the urine specimen with her to the phlebotomy site. Urine
samples were aliquoted in the field and placed into cold boxes.

Participants found to have severe acute malnutrition or severe anemia were referred for treatment at the
nearest health hospital or clinic (see appendix 8.14 for referral form). No efforts were made to collect blood in
a fasting state as this was not required since no biomarkers sensitive to fasting state were measured.

At the end of each day, the team leader reviewed and collated the biological forms and consent forms, and
reviewed data collected in KoboCollect. Interviewers were notified of any errors and/or omissions, whereupon
they were instructed to make the necessary corrections, when possible.

2.5.6. Cold chain and processing of blood samples

Following collection, all blood samples were placed on cold packs (at +4°C to +8°C) until processing.
Phlebotomists recorded the temperature inside ice chests containing the cold packs every two hours.

Every evening, when the field teams stopped their daily work, the blood and urine samples were transported to
the regional processing laboratories. Upon arrival at the regional processing laboratories, the blood collection
tubes were centrifuged at 3,000 rpm for 7 min to separate the plasma from the erythrocytes, platelets, and
leukocytes. Subsequently, plasma was pipetted from the blood collection tubes and aliquoted into cryovials
appropriately labelled with the respondents’ ID numbers. Aliquots destined for different laboratories were
sorted into their corresponding storage boxes/ bags and stored frozen at around -20°C. Urine samples were
sorted and frozen at around -20°C. Upon completion of field work in all regions the plasma and urine samples
were collected and transported frozen to the central processing laboratory in Bishkek. There, blood and urine
samples were consolidated and sent to international laboratories for analyses using dry ice. All blood samples
were analyzed within 6 months of collection.

Flour and salt samples were periodically sent to the laboratory of the Department on Diseases Prevention and
State Sanitary Epidemiological Surveillance.

2.5.7. Supervision of fieldwork

Supervision was provided consistently. During the first week of field work, intense supervision was conducted
to identify and address any flaws, as well as to provide initial quality assurance. In addition to team leaders,
roaming supervisor from the Ministry of Health and various organizations ensured that the correct survey
procedures were followed, i.e. a follow-up quality assurance measure was performed.

2.6. Definitions of indicators and specimen analysis

2.6.1. Infant and young child feeding indicators

IYCF indicator definitions follow the UNICEF-WHO IYCF guidelines published in 2021 [28].

2.6.2. Anthropometric indicators

Children under five

In children 6-59 months of age, undernutrition (including wasting, stunting, and underweight) and overnutrition
were calculated using WHO Child Growth Standards [31]. Children with z-scores below -2.0 for weight-
for-height, height-for-age, or weight-for-age are defined as wasted, stunted, or underweight, respectively.
Moderate wasting, stunting, and underweight are defined as a z-score less than -2.0 but greater than or equal
to -3.0. Z-scores less than -3.0 define severe wasting, severe stunting, or severe underweight. Overnutrition is
defined as a weight-for-height z-score greater than +2.0. Overweight is a weight-for-height z-score of greater
than +2.0 but less than or equal to +3.0. Obesity is defined as a weight-for-height z-score greater than +3.0.

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 REPORT- OCTOBER 2022

Children with z-scores below -2.0 for head circumference-for-age are defined as having microcephaly. For
children 6-59 months of age, a data quality assessment was conducting using the “ENA for SMART 2020” data
analysis program (see Appendix 8.15).

Children 5 years to 9 years of age

In children aged 5-9 years, undernutrition (including acute malnutrition, short stature, and underweight)
and overnutrition was calculated using WHO growth reference for children 5-9 years of age and adolescents
[32]. Children with z-scores below -2.0 for height-for-age or weight-for-age are defined as being of short
stature or underweight, respectively; acute malnutrition (or thinness) is defined as children having BMI-
for-age z-score -2.0 or less.

Overweight is defined as a BMI-for-age z-score of >+1, while obesity will be defined as a BMI-for-age z-score
of >+2 [33].

Adolescent girls 10-18 years of age

In adolescent girls aged 10-18 years, undernutrition (including short stature, and underweight) and overnutrition
was calculated using WHO growth reference for children 5-9 years of age and adolescents [32]. Girls with
z-scores below -2.0 for height-for-age are defined as being of short stature; acute malnutrition (or thinness)
will be defined as children having BMI-for-age z-score -2.0 or less.

Overweight will be defined as a BMI-for-age z-score of >+1, while obesity will be defined as a BMI-for-age
z-score of >+2 [33].

Non-pregnant women

Chronic energy deficiency and overnutrition in non-pregnant women were assessed by using BMI. The most
commonly used cut-off points for BMI to define levels of malnutrition in non-pregnant women have been applied
(19): <16.0 severe undernutrition, 16.0-16.9 moderate undernutrition, 17.0-18.4 at risk of undernutrition, 18.5-
24.9 normal, 25.0-29.9 overweight and >30 obese.

Pregnant women

Because body weight in pregnancy is increased by the products of conception and extra body fluid, BMI is not a valid
indicator of nutritional status. Thus, MUAC was used instead to measure the nutritional status of pregnant women.
A MUAC of less than 23.0 cm was used to define a pregnant woman as undernourished [34].

2.6.3. Blood and urine specimens

The cut-off values for each biomarker indicator used to determine nutritional status for each participant are
presented in Table 4. For hemoglobin and urinary iodine concentrations, multiple cut-offs were used to classify
the severity of anemia and iodine status. For other indicators, a single cut-off was used to identify deficiency
or abnormality.

Table 4. Clinical cut-off points and classifications for biomarker indicators

Indicator* Excess Adequate Mild Moderate Severe

Urinary Iodine Concentration [35]

Non-pregnant non-lactating wom- ≥ 300 µg/L 100-299 µg/L 50-99 µg/L 20-49 µg/L <20 µg/L
en, AG

Non-pregnant lactating women ≥ 250 µg/L ≥ 100 µg/L < 100 µg/L

PW 150-249 µg/L < 150 µg/L

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Hemoglobin [36] 1

PSC -- ≥ 110 g/L 100-109 g/L 70-99 g/L <70 g/L

SAC -- ≥ 115g/L 110-114 g/L 80-109 g/L <80 g/L

AG 10-11 years -- ≥ 115g/L 110-114 g/L 80-109 g/L <80 g/L

AG >11 years and NPW -- ≥ 120 g/L 110-119 g/L 80-109 g/L <80 g/L

Pregnant women -- ≥ 110 g/L 100-109 g/L 70-99 g/L <70 g/L
Deficiency cut-offs
Retinol [37]
PSC, SAC, AG, NPW <0.7 µM/L2,3
Retinol-binding protein
PSC, SAC, AG, NPW <0.569 µM/L2,3
Plasma ferritin [38] < 12 µg/L2
PSC,
SAC, AG, NPW < 15 µg/L2
α1-acid-glycoprotein [39]
PSC, SAC, AG, NPW >1 g/L
C-reactive protein [39]
PSC, SAC, AG, NPW >5 mg/L
Folate [40]
AG and NPW <10 nmol/L (<4.4 ng/mL)
25[OH]D 4

PSC, AG and NPW <12ng/ml (30nmol/L); deficiency); <20 ng/mL (50nmol/L; insufficiency)
* AG, Adolescent girls 10-18 years; NPW, non-pregnant women 19-49 years; PSC, children 6-59 months of age; PW, pregnant women;
SAC, children 5-9 years.
1
Because the normal hemoglobin differs by altitude and smoking, the cut-off for defining normal hemoglobin concentrations was ad-
justed for these factors, see because hemoglobin concentration is affected by altitude, the WHO recommends an altitude adjustment
as shown in Table 5 and Table 6.
2
These indicators were adjusted for sub-clinical inflammation using appropriate algorithms [41,42].
3
No established deficiency cut-offs have been developed for RBP, and as such the linear correlation between RBP and plasma retinol
was used to estimate a vitamin A deficiency cut-off of 0.569 µm/L (see page 19 and appendix 8.6). Further, for adult women, no
thresholds exist but in literature, the same cut-off as for children is being used.
4
There is no consensus cut-off point for 25[OH]D to define vitamin D deficiency. The cut-off <20ng/mL is used by NHANES and many
other surveys.

Because hemoglobin concentration is affected by altitude, the World Health Organization recommends an
altitude adjustment, as shown in Table 5

Table 5. Adjustments in cut-off defining anemia, by altitude of residence [43]

Altitude (meters) Increase in cut-off point defining anemia (g/L)

< 1000 No adjustment
1000 – 1249 +2
1250 – 1749 +5
1750 – 2249 +8

The NIMAS adjusted the cut-off defining normal hemoglobin concentrations in adolescent girls and women
based on the number of cigarettes smoked per day as per the WHO recommendations [44] (see Table 6).

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Table 6. Adjustments in cut-off defining anemia, by smoking status (Adapted from [44])

Cigarettes smoked per day Increase in cut-off point defining anemia (g/L)
< 10 per day No adjustment
10 – 19 per day +3
20 – 39 per day +5
40 + per day +7
Smoker, amount unknown +3

Anemia

Blood hemoglobin concentration was measured using a HemoCue™ portable hemoglobinometer (Hb301,
HemoCue, Ångelholm, Sweden, new devices calibrated by manufacturer). Quality control of the Hemocue
devices was done daily using low and medium concentration liquid control blood commercially available
(Eurotrol, Ede, The Netherlands). Control blood was kept in cold boxes (2-8°C) for the duration of the field work
to prevent degradation. Because anemia prevalence estimates obtained by using portable hemoglobinometers
are being debated currently [45–48], a complete blood count (CBC) was conducted in all samples collected in
the Bishkek stratum using Mindray BC-600 (China) analyzer in order to validate the HemoCue results. The
CBC was conducted by Aqualab Bishkek by highly trained personnel and using daily quality control measures.

Iron (plasma ferritin), retinol binding protein, retinol & acute phase proteins (CRP, AGP)

Plasma ferritin, retinol binding protein, CRP and AGP were analyzed by the VitMin Laboratory in Germany,
which regularly participates in Center for Disease Control and Prevention (CDC)s VITAL-EQA quality program.
The laboratory used a combined and optimized sandwich ELISA technique using a single small-volume plasma
sample [49], which has recently been validated against the methods used by United States NHANES [50].

Ferritin is recommended by the World Health Organization for population-based assessment of iron status
because it is responsive to iron interventions overtime [51]. Retinol binding protein (RBP) was used to assess
the vitamin A status of all individuals in the survey. RBP can be analyzed with small quantities of plasma. It
is highly correlated with plasma retinol [52], the biomarker of vitamin A status recommended by the World
Health Organization [53]. Because RBP is not a WHO-recommended biomarker for assessment of vitamin A
status, the correlation between the RBP results and plasma retinol measured by high-performance liquid
chromatography (HPLC) was checked by testing a subset of plasma specimens from children, adolescent
girls and non-pregnant women at the Swiss Vitamin Institute in Lausanne, Switzerland and the VitMin
Laboratory, Germany. The laboratories have repeatedly participated and performed well in this analysis in
the CDC external quality assurance program Vital-EQA. Comparisons of retinol and RBP values and more
details are presented in Appendix 8.6. There was strong correlation between retinol and RBP values when
compared as continuous values, yet the RBP values were consistently lower than their respective retinol
counterparts. As such, the regression equation was used to estimate the RBP cut-off for defining vitamin A
deficiency, resulting in a cut-off of 0.569 µmol/L; this cut-off value was subsequently used to define vitamin
A deficiency throughout this report.

However, both ferritin and RBP concentrations are affected by inflammation; ferritin concentrations are
elevated and RBP concentrations are suppressed in the presence of the acute phase proteins alpha-1-
acid-glycoprotein (AGP) and C-reactive protein (CRP). Due to this inflammatory response, ferritin and RBP
concentrations were adjusted for inflammation using the correction algorithm developed by the Biomarkers
Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) [42,54].

Specifically, the BRINDA equation and correction factors were used to adjust ferritin concentrations in
children 6-59 months of age and non-pregnant women 15-49 years of age, and RBP concentrations in
children 6-59 months of age. The BRINDA project does not recommend adjusting RBP in non-pregnant
women 15-49 years of age.

The BRINDA project does not, however, have correction factors for children 5-9 years of age and adolescent
girls, and has recommended that internal correction factors — or correction factors calculated from a specific
dataset — be used for other population groups [55] if an association between ferritin and inflammation
biomarkers is observed.

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For ferritin, pairwise correlations showed a significant continuous association between ferritin and CRP, and
between ferritin and AGP in both children 5-9 years of age and adolescent girls. As such, internal correction
factors were calculated and used in tandem with the BRINDA equation to adjust ferritin concentrations for
inflammation.

For RBP, pairwise correlations showed a significant association between RBP and CRP, and between RBP and
AGP in children 5-9 years of age. As with ferritin, internal correction factors were calculated and used with the
BRINDA equation to adjust RBP concentrations. RBP was not adjusted for adolescent girls, as the age range of
this population group — 10 to 18 years of age — overlaps with age range of non-pregnant women.

Prior to conducting the inflammation adjustments, CRP concentrations below the level of detection (i.e., <0.2
mg/L) were replaced with randomly generated values between 0 and 0.2 mg/L, as this has been shown to
improve the reliability of the inflammation adjustment [56].

Plasma folate

Plasma folate is used to assess short-term folate status and is highly responsive to increased intakes of
folate naturally present in foods and folic acid added during fortification [57]. Plasma folate concentrations
were measured using electro-chemoluminescence on a Roche e600 SER/E170 analyzer at Biolab in Amman,
Jordan. Since no folate cut-offs using macrocytic anaemia as the threshold have been defined for protein-
binding assays, we defined folate deficiency as the folate concentration (<10 nmol/L) at which homocysteine
levels begin to increase, as recommended by WHO [40]. To assure quality of the folate analyses, the laboratory
participates in quality assurance programs and has a long-standing track-record of successful external quality
control (Randox laboratories and College of American Pathologists) and has recently enrolled with CDC’s
VITAL-EQA program.

Plasma vitamin D

Plasma 25(OH)D concentrations were analyzed by Biolab Amman using the Diasorin Liaison analyzer
(chemiluminescence). For plasma 25(OH)D the laboratory successfully participates in the external quality
control program of the College of American Pathologists.

Urinary iodine

The WHO recommends measuring iodine in urine for population-based surveys [58]. Urinary iodine results
serve as an approximate reflection of recent iodine intake, but substantial intra-individual diurnal variation is
a major limitation of this biomarker for clinical diagnosis.

Urinary iodine was analyzed by the Tanzania Food and Nutrition Center, which regularly participates CDCs
Ensuring the Quality of Urinary Iodine Procedures (EQUIP) quality program. Further, the Tanzania Food and
Nutrition Center is recognized as an Iodine Global Network laboratory. The iodine in the urine was then
measured by a modification of the traditional colorimetric method of Sandell-Kolthoff as proposed by Pino
et al [59].

2.6.4. Food samples

Analysis of salt and flour samples

Salt and flour samples were analyzed by the laboratory of the Department on Diseases Prevention and State
Sanitary Epidemiological Surveillance in Bishkek. Iodine in salt was first measured qualitatively using a rapid
test kit (RTK) for iodate. Subsequently, a quantitative analysis was conducted using the iReader device (Mahidol
University, Bangkok, Thailand) [60] on samples testing positive when using RTK. After every ninth sample, a
quality control sample was measured. This external quality control sample was prepared by Südwestdeutsche
Salzwerke AG, Heilbronn, Germany. Laboratory technicians were trained on the analytical procedures specific
to the NIMAS.

To determine iron concentration in the wheat flour samples the iCheck Iron device was used (BioAnalyt,
Potsdam, Germany; [61]). iCheck Iron is a portable all-inclusive test kit that measures iron in a wide range of
premixes and foods using a single-wavelength photometer, pre-calibrated for quantitative measurement of
iron. As different sample dilution methods were needed with iCheck depending on the iron compound added
to the wheat flour during fortification, a rapid spot test was performed prior to the iCheck analysis, which

38
 REPORT- OCTOBER 2022

allowed to distinguish between Sodium Iron ETDA (NaFeEDTA), ferrous sulfate or ferrous fumarate. After every
ninth sample, a quality control sample was measured. Laboratory technicians were trained on the analytical
procedures specific to the NIMAS.

2.7. Data management and analysis

2.7.1. Data entry

Direct electronic data entry was done using KoboCollect during the household, child, and women interviews. For the
parts of the individual questionnaires (biological form) that were completed by the anthropometrist/phlebotomist
using a paper form, the interviewers entered the data into KoboCollect on the same or the following day. Completed
questionnaires were cross-checked on a daily basis by the team leaders prior to data uploading to a cloud-based
secure server.

2.7.2. Data monitoring

Interview data uploaded from the tablets to the cloud were monitored continuously and a weekly monitoring
report was prepared. In case of systematic and sporadic errors made by one or several teams, all team leaders
were immediately informed about the problem, so the problem was not repeated. For errors that the teams
could address, they were requested to do so immediately, while still in a given PSU. For some variables, such
data quality checks could not be done immediately (e.g., composite anthropometric indicators) and thus, during
data analysis, quality checks were conducted to assess the quality of the data collected.

2.7.3. Data analysis

Data analysis was done using Stata/IC version 17. All analyses of questionnaire data, biomarkers and salt
samples were conducted using a weighted analysis to account for the unequal probability of selection in the
9 strata. However, tables presenting the summary of the survey sample accounted for unequal probability of
selection of primary sampling units, but each household, child, or woman were equally weighted to produce
summary figures.

For continuous variables, means with standard deviations and medians with interquartile ranges were calculated
for normally distributed and skewed data, respectively. Regarding urinary iodine concentrations (UIC), median
UICs were calculated for each target group overall and for subgroups in order to judge population iodine status
against WHO criteria [58]. However, in order to judge the statistical precision of apparent differences among
subgroups, a square root transformation of the UIC values created a variable which was normally distributed
[62]. Linear regression was then used to calculate p-values for apparent association between the geometric
UIC means and each characteristic.

For categorical variables, proportions were calculated to derive the prevalence of various outcomes. The
statistical precisions of all prevalence estimates were assessed by using 95% confidence limits which were
calculated accounting for the complex sampling used in this survey, including the cluster and stratified
sampling. All measures of precision, including confidence limits and chi square p-values for differences, were
calculated accounting for the complex cluster and stratified sampling used by the NIMAS 2021.

Descriptive statistics were calculated for children 6-59 months of age, children 5-9 years of age, adolescent
girls and non-pregnant women (i.e., across all strata), for each stratum separately and by sex (for children).
Results are also presented by specific age sub-groups for non-pregnant women and children. For example,
results are presented for children 6-11 months, 12-23 months, 24-35 months, 36-47 months, and 48-59
months of age; for SAC, yearly intervals served as the sub-group age ranges. Age subgroups for non-pregnant
women are 15-19 years, 20-29 years, 30-39 years, and 40-49 years. For adolescent girls, sub-groups include
pre-menarche and menarche. For pregnant women, only national estimates for all ages have been generated
and little subgroup analysis was possible due to the small sample size.

Females aged 15-18 years belonged to 2 different groups: a) adolescent girls and b) non-pregnant women. All
females aged 15-18 years were included in the adolescent girl data analyses. For the non-pregnant women

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

analyses, females aged 15-18 years were only included from every second household following the same
selection procedure as for non-pregnant women 19-49 years of age.

Calculation of composite variables

Wealth index: Using data on each household’s dwelling, water and sanitation conditions and facilities, and
ownership of durable goods, a wealth index was calculated using the World Bank method [63]. Calculation of
wealth index quintiles was used to categorize the continuous wealth index and permit the cross-tabulation and
the subsequent presentation of key indicators by wealth.

Household sanitation: Composite variable of toilet type and if toilet facilities are shared with non-household
members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another
household. Inadequate sanitation= open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field.

Safe drinking water: Composite variable of main source of drinking water and treating water to make safe for
drinking. Improved source of drinking water was defined as water from piped system, tube well or borehole,
protected well, protected spring, rainwater collection, bottled water or sachet water. Unimproved source was
defined as water from unprotected well, unprotected spring, tanker truck or cart, surface water or other.

Minimum dietary diversity: For women, adolescent girls, and children 5-9 years of age, minimum dietary
diversity was calculated using the FANTA W-MDD method [29]. For the calculation of the IYCF complementary
feeding indicator for children 6-23 months of age, the 2021 updated WHO/UNICEF guideline on indicators for
assessing infant and young child feeding practices was used, which defines minimum diversity as consuming
foods and beverages from at least five out of eight defined food groups (including breast milk) during the
previous day [28]. For children 6-59 months of age, minimum dietary diversity was defined using the same
defined food groups as for children 6-23 months, but excluding breast milk; thus minimum dietary diversity
was achieved if these children ate at least four out of seven food groups. For all other population groups
minimum dietary diversity was defined as the consumption of at least 5 food groups.

Food security: To determine each household’s access for food in the past 30 days, household questionnaires
included the Household Food Insecurity Access Scale (HFIAS) module. Specifically, nine separate yes/
no questions were asked to gauge if different aspects of food insecurity existed in the past 30 days, and
if so, a follow up question was asked to determine the frequency of the occurrence. Question responses
were summed to produces a food insecurity score for each household, which in turn was classified into a
food insecurity category according to guidelines developed by the Food and Nutrition Technical Assistance
(FANTA) project [64].

Clean/solid fuel: Solid fuels include coal/lignite, charcoal, wood, straw/shrub/grass, agricultural crops, and
animal dung. Clean fuels include electricity, liquefied petroleum gas (LPG), natural gas, and biogas [65].

40
 REPORT- OCTOBER 2022

3. RESULTS

3.1. Study participation of households, children, and women

Figure 2 below provides an overview of the number of respondents at the different survey stages. Only about
11% of households were absent or refused to participate in the survey. Among women and adolescent girls
residing in the participating households, 2250 women and adolescent girls agreed to participate and completed
the individual interview. Anthropometric measurements and blood (hemoglobin) were collected from 1799
and 1802 non- pregnant women and adolescent girls, respectively. Overall, 1557 children 6-59 months old
participated in the survey, of which 1323 completed anthropometry measurements. Hemoglobin measurements
were obtained from 1211 children 6-59 months old. Among children aged 5-9 years residing in the participating
households, 1730 completed the individual interview. Anthropometric measurements and blood (hemoglobin)
were collected from 1464 and 1417 children 5-9 years of age, respectively.

Figure 2. Participation flow diagram for households, women, adolescent girls and children, the Kyrgyz
Republic 2021

3452
HHs randomly selected

28 no competent respondent
112 absent for long period of time 3062 (89%)
177 refused HHs randomly selected
73 other reasons

1604 1774 2192

eligible PSC eligible SAC eligible AGs & NPW

2074 (95%)
1554 (97%) 50 1730 (98%) 44 118
AGs & NPW
PSC interviews refused SAC interviews refused refused
interviews
completed of absent completed of absent of absent
completed

1323 (82%) 231 1464 (83%) 266 393 385

PSC with refused or SAC with refused or refused or refused or
anthropometric incomplete anthropometric incomplete incomplete incomplete
measurement data measurement date date date

112 47 1799 (76%) 1807 (82%)

1211 (75%) 1417 (80%)
refused or refused or AGs & NPW with AGs & NPW
PSC with blood SAC with blood
incomplete incomplete anthropometric with blood
sample* sample*
date date measurement sample*

HH: household; PSC: pre-school child 6-59 months; SAC: school-age child 5-9 y; 176 eligible PW
AG: adolescent girls 10-18 y; NPW: non-pregnant woman 15-49 y; 176 interviews completed
PW: pregnant woman (43 without MUAC)
*Valid Hb measurement (34 without Hb results)

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.2. Household characteristics

3.2.1. Demographic characteristics

The characteristics of participating households in the NIMAS 2021 are summarized in Table 7, Table 8,
and Table 9 below. In total, 3062 households were included, with about 60% recruited from rural areas. On
average, households contained about 4.3 members. A large majority of households in the Kyrgyz Republic have
household heads who are of Kyrgyz ethnicity, followed by Uzbek and Russian. Almost 60% of the household
heads are male and about 90% of the household heads completed secondary school or higher.

Table 7. Characteristics of participating households, the Kyrgyz Republic 2021

Characteristic N %a % in most recent census [63]

Urban/rural
Urban 1370 40.1 34
Rural 1692 59.9 66
Region
Batken oblast 298 7.0 8
Jalal-Abad oblast 321 16.0 19
Issyk-Kul oblast 352 8.8 8
Naryn oblast 312 4.6 4
Osh oblast 332 17.0 21
Talas oblast 283 4.1 4
Chui oblast 308 16.9 15
Bishkek city 476 20.4 16
Osh city 380 5.2 5
Wealth quintile
Lowest 686 20.0
Second 593 20.0
Middle 575 20.0
Fourth 602 20.1
Highest 606 19.9
Ethnicity of household
Kyrgyz 2369 76.4
Russian 203 8.0
Узбек 398 11.7
Other 92 4.0
First language of
Kyrgyz 2327 74.3
Uzbek 395 11.6
Russian 316 12.9
Other 24 1.1
Sex of household head
Male 1879 58.5
Female 1183 41.5
TOTAL 3062
Note: The N’s are the denominators for a specific sub-group.
a
All percentages except region-specific estimates are weighted for unequal probability of selection.

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 REPORT- OCTOBER 2022

Table 8. Household composition of participating households, the Kyrgyz Republic 2021

Characteristic N %a or mean (95% CI) b

Average household size
Mean 3062 4.3 (4.2, 4.5)
Number of household (HH) members
1 251 8.5 (7.2, 10.0)
2 434 14.8 (13.5, 16.3)
3 483 16.1 (14.4, 17.8)
4 486 15.8 (14.3, 17.4)
5 465 15.3 (13.9, 16.8)
6 392 12.3 (11.2, 13.6)
7 288 9.1 (8.0, 10.4)
8+ 263 8.1 (7.0, 9.4)
Proportion of HHs with given number of women 15-49 years of age
0 2159 16.5 (15.1, 18.0)
1 8194 59.9 (57.7, 62.1)
2 2473 19.1 (17.0, 21.3)
3 635 4.3 (3.3, 5.6)
4 58 0.2 (0.1, 0.6)
Proportion of HH with given number of adolescent girls 10-18 years of age
0 2246 73.7 (71.9, 75.4)
1 624 20.5 (19.0, 22.1)
2 162 4.9 (4.0, 5.9)
3 27 0.8 (0.5, 1.2)
4 3 0.1 (0.0, 0.4)
Proportion of HH with given number of children 6-59 months of age
0 1891 62.5 (60.2, 64.7)
1 759 24.3 (22.4, 26.3)
2 364 11.6 (10.4, 13.0)
3 43 1.3 (1.0, 1.8)
4 5 0.2 (0.1, 0.5)
Proportion of HH with given number of children 5-9 years of age
0 1801 60.1 (58.1, 62.1)
1 799 25.3 (23.6, 27.0)
2 386 11.9 (10.6, 13.3)
3 67 2.4 (1.9, 3.1)
4 6 0.2 (0.1, 0.5)
5 3 0.1 (0.0, 0.2)
TOTAL 3062 -- --
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.

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Table 9. Educational level of household head for participating households, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Head of household ever attended school or preschool
Yes 2953 96.7 (95.8, 97.4)
No 102 3.1 (2.4, 3.9)
Don’t know 7 0.3 (0.1, 0.6)
Highest level of school attended by household head
Primary 33 1.4 (1.0, 2.0)
Basic secondary 278 8.8 (7.5, 10.3)
Complete secondary 1161 39.6 (36.9, 42.3)
Professional Primary/ middle 834 28.8 (26.7, 31.1)
Higher 631 20.9 (18.9, 23.0)
Don`t know 16 0.5 (0.2, 0.9)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.2.2. Cooking fuel and household lighting

As shown in Table 10, nearly 80% of participating households used clean fuel for cooking, and nearly all
households used electricity from the electricity grid to light their house. Regarding home heating, more than
half of the participating households used a solid fuel source exclusively, and nearly one-quarter of households
used clean heating fuel. Both clean and solid fuels were used in tandem by about 20% of households.

3.2.3. Household food insecurity

Table 11 presents the household food insecurity status for residence, region, and wealth quintile, showing
food insecurity status is significantly associated with all of them. Regarding residence, urban households are
significantly more food secure than rural households, but the difference in the prevalence (~6%) of Household
food securitys is relatively small. Issyk-Kul, Naryn, Talas, and Chui have the highest proportions (40-48%) of
food insecure households. The proportion of Household food securitys is also correlated with wealth quintile,
with higher proportions of Household food securitys as wealth quintile increases.

Food insecurity status is presented by category (i.e., food secure, mildly food insecure, moderately food
insecure, severely food insecure) in Table 88 in appendix 8.1. The proportion of households with severe food
insecurity is higher in rural areas compared to urban centers. Moreover, the largest proportion of severely
food insecure households was found in Chui (11%) and Naryn (8.6%), while few households are severely food
insecure in Jalal Abad and Bishkek. Further, households of the lowest wealth quintile are more likely to be
severely food insecure than households of the other wealth quintiles.

Table 10. Type of energy used for cooking, lighting and heating in participating households, the Kyrgyz
Republic 2021

Characteristic N %a (95% CI))b

Type of fuel used for cooking
Clean fuelc 2461 78.0 (75.8, 80.1)
Solid fuelc 576 21.5 (19.4, 23.7)
No food cooked in household / Don’t know / Other 25 0.5 (0.3, 0.8)
How household is lit at night
Mains electricity 3055 99.7 (99.4, 99.9)
Solar energy 2 0.1 (0.0, 0.3)

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 REPORT- OCTOBER 2022

Kerosene/ paraffin 1 0.0 (0.0, 0.3)

Firewood 2 0.1 (0.0, 0.3)
Biogas lamp 1 0.0 (0.0, 0.3)
Gasoline lamp 1 0.0 (0.0, 0.3)
Type of fuel or energy used to heat the house c

Clean fuel only 707 23.2 (19.9, 26.9)

Solid fuel only 1700 55.1 (51.8, 58.2)
Clean and solid fuel 636 21.1 (18.6, 23.9)
Household does not have heating 2 0.0 (0.0, 0.2)
Other heating source 12 0.3 (0.2, 0.8)
Don`t know 5 0.2 (0.1, 0.6)
TOTAL 3062
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a Percentages weighted for unequal probability of selection.
b CI=confidence interval, calculated taking into account the complex sampling design.
c Clean fuels include electricity, liquefied petroleum gas (LPG), natural gas, and biogas. Solid fuels include coal/lignite, charcoal, wood,
straw/shrub/grass, and animal dung.

Table 11. Household food insecurity score (HFIAS) categories, by residence, region, and wealth quintile, the
Kyrgyz Republic 2021

Food secure, Food insecure,

Characteristic N (95% CI)b (95% CI)b P-valuec
%a %a
Residence
Urban 1370 73.9 (70.0, 77.4) 26.1 (23.1, 29.3) <0.01
Rural 1692 68.1 (65.1, 71.0) 31.9 (29.3, 34.6)
Region
Batken oblast 298 77.4 (70.8, 82.9) 22.6 (17.1, 29.2) <0.001
Jalal-Abad oblast 321 85.4 (79.4, 89.8) 14.6 (10.1, 20.8)
Issyk-Kul oblast 352 56.4 (49.7, 62.9) 43.6 (37.7, 49.7)
Naryn oblast 312 53.2 (49.0, 57.3) 46.8 (42.7, 51.0)
Osh oblast 332 75.2 (69.4, 80.3) 24.8 (19.6, 30.7)
Talas oblast 283 60.4 (53.9, 66.4) 39.6 (33.5, 46.1)
Chui oblast 308 52.2 (46.8, 57.7) 47.8 (42.5, 53.1)
Bishkek city 476 78.5 (73.2, 83.0) 21.4 (17.0, 26.7)
Osh city 380 73.7 (69.4, 77.6) 26.3 (22.4, 30.6)
Wealth quintile
Lowest 686 53.4 (48.6, 58.2) 46.5 (41.8, 51.3) <0.001
Second 593 65.7 (61.1, 69.8) 34.3 (30.1, 38.8)
Middle 575 76.2 (72.6, 79.5) 23.9 (20.7, 27.4)
Fourth 602 77.1 (72.7, 80.7) 23 (19.2, 27.1)
Highest 606 79.9 (74.6, 84.3) 20.1 (15.9, 25.0)
TOTAL 3062 70.4 (68.4, 72.5) 29.6 (27.5, 31.6)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Chi-square p-value <0.05 indicates that the proportion in at least one subgroup is statistically significantly different from the values
in the other subgroups.

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.2.4. Water and sanitation

As shown in Table 12, almost 95% of the households have an improved source of water for drinking. About
half of the households reported treating their water to make it safe to drink. Thus, almost all participating
households in fact drank safe water. Most households (n=26) that do not consume safe drinking water are
located in Jalal-Abad (data not shown). Regarding sanitation, almost nine out of ten households nationally
have improved sanitation facilities, however, significantly (p<0.001) lower prevalences are found in Batken and
Jalal-Abad (see Figure 3).

Table 12. Indicators of household water and sanitation, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)) b

Main source of water for drinking c
Unimproved source 189 5.3 (3.4, 8.1)
Improved source 2871 94.6 (91.9, 96.5)
Don’t know 2 0.1 (0.0, 0.3)
Treat water to make safe to drink
Yes 1661 47.9 (45.5, 50.4)
No 1392 51.9 (49.5, 54.3)
Don’t know 9 0.2 (0.1, 0.4)
Treatment method (N=1661) d

Boil 1331 79.3 (76.1, 82.3)

Add bleach 33 1.5 (1.0, 2.3)
Strain through cloth 22 1.3 (0.8, 2.0)
Water filter 275 17.5 (14.6, 20.9)
Solar disinfection 20 1.2 (0.7, 1.9)
Let it stand 214 9.4 (7.8, 11.2)
Drink safe water
Yes 3012 98.1 (96.3, 99.0)
No 48 1.9 (0.9, 3.7)
Don’t know 2 0.1 (0.0, 0.3)
Household sanitation f

Adequate 2658 87.2 (85.3, 88.9)

Unadequate 400 12.7 (11.0, 14.6)
Don’t know 4 0.1 (0.0, 0.2)
TOTAL 3062
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Improved source = water from piped system, tube well or borehole, protected well, protected spring, rainwater collection, bottled
water or sachet water. Unimproved source = water from unprotected well, unprotected spring, tanker truck or cart, surface water or
other.
d
Water treatment methods asked to households reporting that some type of water treatment was done (N=1661, and multiple re-
sponses to water treatment method were permitted
e
Composite variable of main source of drinking water and treating water to make safe for drinking.
f
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab or ventilated improved pit latrine not shared with another household. Inadequate sanitation= open
pit, bucket latrine, hanging toilet/latrine, no facility, bush, field.

46
 REPORT- OCTOBER 2022

100

Propoprtion (%)
80

60

40

20

0
st

st

st

st

st

st

ty

ty

ic
as

bl
la

la

la

la

la

la

ci

ci
bl
ob

ob

ob

ob

ob

ob

pu
k

sh
lo

ke

Re
O
en

yn

sh

ui
Ku

sh
la
ba

Ch
O
ar
tk

yz
Ta

Bi
k-
l-A
Ba

rg
sy
la

Ky
Is
Ja

Figure 3. Proportion of households with adequate sanitation facilities, by region

About 70% of the households have a fixed sink or basin for handwashing, and the remaining households wash
hands elsewhere in or around the dwelling. Almost all households had water available at the handwashing site
and had some kind of soap at the handwashing site at the time of the survey (Table 13).

Table 13. Indicators of handwashing, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Location of handwashing site
Fixed place (observed) 2155 71.0 (68.7, 73.1)
Mobile (observed) 847 27.7 (25.6, 29.9)
Not observed, not in dwelling 43 0.9 (0.6, 1.4)
Not observed, permission to see not given 11 0.2 (0.1, 0.5)
Not observed, other reason 6 0.2 (0.1, 0.5)
Water is available at observed handwashing placec
No 149 4.5 (3.6, 5.6)
Yes 2853 95.5 (94.4, 96.4)
Soap seen at handwashing site c

Bar soap, liquid soap, detergent 2873 95.0 (94.0, 95.9)

Ash / mud / sand 46 1.3 (0.9, 1.9)
No soap 122 4.8 (3.9, 5.8)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Results based on households where handwashing site was observed (N=3002), but N’s do not sum to total as multiple responses
permitted.

3.2.5. Salt iodization

About 99% of households had salt in their house at the time of the survey, and almost all participating
households provided a sample to the interviewer. A very high proportion (93.3%) of households believed
that the salt they used was iodized. Note, this result reflects the respondents’ perception of their salt’s
iodization status. More than 70% of surveyed households had salt in its original package, with the package
label stating that it was iodized, whereas about one quarter of the available salt was not in the original
package (see Table 14).

47
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Salt was collected from participating households for subsequent quantitative testing for iodine content at the
central laboratory. Nationally, the median iodine salt concentration in the Kyrgyz Republic is relatively high
(19.7 ppm). As shown in Figure 4, about three quarter of the salt samples are adequately iodized, about one
quarter are inadequately iodized, and a small proportion is not iodized.

Figure 5 presents the distribution of household salt iodine concentration, corroborating that a small
proportion contains less than 5 ppm iodine and none of the salt is over-iodized. While most of the samples
are above the international cut-off of 15 ppm, the majority of the salt is below the cut-off mandated by the
government (25 ppm).

Table 14. Household salt availability, and packaging, the Kyrgyz Republic 2021

Characteristic N %a (95% CI) b

Household uses salt
Yes 3056 99.8 (99.6, 99.9)
No 6 0.2 (0.1, 0.4)
Have salt in house
Yes 3014 98.6 (98.1, 99.0)
No 42 1.4 (1.0, 1.9)
Interviewer able to observe salt storage
Yes 2947 97.7 (96.9, 98.3)
No 67 2.3 (1.7, 3.1)
Salt exposure to light c

Exposed to sunlight 121 5.0 (4.0, 6.1)

Sheltered from sunlight 2826 95.0 (93.9, 96.0)
Respondent believes salt is iodized c, d

Yes 2794 93.3 (92.0, 94.4)

No 20 0.6 (0.4, 1.1)
Don’t know 200 6.1 (5.0, 7.4)
Salt iodization labelling c

Original packaging stating salt is iodized 2111 71.9 (69.6, 74.0)

Original packaging without mention of iodization 64 2.7 (1.9, 3.9)
Undetermined, not in original package 684 23.2 (21.4, 25.2)
Undetermined for other reasons 88 2.2 (1.8, 2.8)
Most commonly used salt brands e

Bereke 764 35.4 (31.9, 39.1)

Kartuz 624 30.4 (27.6, 33.5)
Extra 373 19.0 (16.6, 21.6)
Araltuz 299 9.6 (8.0, 11.4)
Osh Tuzu 39 1.9 (0.9, 4.0)
Salamat 19 1.2 (0.5, 2.5)
Extra Povarenok 10 0.5 (0.2, 1.1)
Nur 10 0.5 (0.3, 1.0)
Other 42 1.6 (1.1, 2.2)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Results based on households that had salt in the house at the time of the survey.
d
This variable was calculated based on respondents’ perceptions about whether or not salt was iodized.
e
Results (n=2180) exclude salt not in original package.

48
 REPORT- OCTOBER 2022

1,8%

22,5%
0 - <5 ppm

5 - 14,9 ppm

≥15 ppm

75,6%

Figure 4. Salt iodine concentration by categories not iodized (0-<5ppm), inadequately iodized (5-14.9ppm) and
adequately iodized (≥ 15 ppm), the Kyrgyz Republic 2021

20%

15%

10%

5%

0
0 5 10 15 20 25 30 35 40 45 50 55 60
Iodine concentration in salt (ppm)

Figure 5. Distribution of household salt iodine concentrations, the Kyrgyz Republic 2021

As shown in Table 15, a significantly larger proportion of households in urban than rural areas have adequately
iodized salt. Significant differences were also found by region: More than 95% of households in Bishkek have
adequately iodized salt, whereas just over 60% of surveyed households have adequately iodized salt in Batken,
Issyk Kul, and Osh City (see also Figure 6). Moreover, significant differences were found by household wealth,
with a larger proportion of households in the highest quintile using adequately iodized salt. While no association
was detected between food insecurity and adequate salt iodization, significantly fewer households with severe
food insecurity have iodized salt (i.e., any amount of iodine) at home compared to other households. Similarly,
significant differences in the proportion of households with iodized salt (any level) were found for residence,
region and wealth quintile. Surprisingly, neither the label, nor the salt brand is significantly associated with
iodization (any level). Surprisingly, the proportion of adequately iodized salt is higher in samples that were not
labelled as iodized compared to salt in the original packaging stating that it is iodized.

49
 Table 15. Доля домохозяйств, в которых соль была йодирована a и адекватно йодирована, Kyrgyzская Республика a, 2021 год

50
Median iodine Iodizeda Adequately iodized (≥15ppm)a Adequately iodized (≥25ppm)a
Characteristic N concentration
(ppm) %b (95% CI)c P-valued %b (95% CI)c P-valued %b (95% CI)c P-valued
Residence
Urban 1256 20.67 99.0 (98.1, 99.5) <0.05 80.8 (78.0, 83.3) <0.001 37.2 (33.2, 41.4) <0.01
Rural 1606 19.01 97.6 (96.3, 98.5) 72.3 (69.4, 75.0) 30.0 (27.0, 33.2)
Region
Batken oblast 295 17.25 97.4 (93.6, 98.9) <0.05 62.3 (53.5, 70.3) <0.001 17.0 (13.3, 21.6) <0.001
Jalal-Abad oblast 304 24.62 99.0 (97.1, 99.7) 71.4 (64.6, 77.3) 44.7 (38.4, 51.3)
Issyk-Kul oblast 336 16.07 98.5 (96.1, 99.5) 65.6 (60.4, 70.5) 7.4 (4.6, 11.8)
Naryn oblast 287 17.14 99.3 (97.3, 99.8) 68.0 (61.8, 73.5) 23.0 (17.7, 29.2)
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Osh oblast 304 16.83 96.6 (92.0, 98.6) 70.6 (63.7, 76.7) 27.3 (20.3, 35.5)
Talas oblast 278 21.74 95.6 (91.2, 97.8) 78.1 (72.1, 83.2) 35.4 (28.4, 43.1)
Chui oblast 281 20.35 97.5 (94.8, 98.8) 78.3 (74.1, 82.0) 36.3 (30.8, 42.2)
Bishkek city 417 23.45 100 - 95.4 (92.9, 97.1) 46.5 (39.5, 53.7)
Osh city 360 16.79 97.5 (93.7, 99.0) 64.9 (58.3, 70.9) 25.0 (20.1, 30.6)
Wealth quintile
Lowest 652 18.36 97.3 (94.9, 98.6) <0.005 72.8 (68.9, 76.3) <0.001 25.4 (21.2, 30.0) <0.001
Second 564 19.82 98.2 (96.5, 99.1) 72.7 (67.9, 76.9) 31.9 (27.2, 37.0)
Middle 538 17.40 96.8 (94.8, 98.1) 66.8 (61.6, 71.6) 29.8 (25.2, 34.9)
Fourth 571 20.09 98.9 (97.6, 99.5) 77.9 (73.6, 81.7) 32.1 (27.5, 37.1)
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Highest 535 22.60 99.7 (98.5, 99.9) 88.9 (85.7, 91.5) 46.0 (39.3, 52.7)
Household food security
Secure 1954 20.13 98.5 (97.7, 99.0) <0.05 76 (73.6, 78.3) 0.621 34.1 (31.2, 37.2) 0.299
Mildly insecure 320 18.90 97.7 (94.9, 98.9) 72.5 (66.5, 77.8) 29.8 (23.8, 36.5)
Moderately insecure 425 19.65 98.0 (96.0, 99.0) 76.6 (72.1, 80.5) 29.4 (24.7, 34.7)
Severely insecure 163 18.69 94.8 (86.4, 98.1) 73.8 (64.9, 81.1) 31.2 (23.5, 40.2)
Packaging of salt
Original packaging stating salt is 2013 18.73 98.0 (96.9, 98.7) 0.708 73.2 (70.6, 75.7) <0.005 30.1 (27.4, 33.0) <0.01
iodized
 Original packaging without men- 54 21.39 98.9 (92.1, 99.8) 87.7 (74.5, 94.5) 37.9 (23.8, 54.4)
tion of iodization
Undetermined, not in original 649 22.0 98.2 (96.7, 99.0) 79.6 (75.8, 82.9) 39.1 (34.1, 44.3)
package
Undetermined for other reasons 82 23.89 100 - 86.6 (76.9, 92.7) 40.2 (28.3, 53.3)
Salt brand (n=2072)
Bereke 724 18.45 98.8 (97.5, 99.4) <0.05 75.1 (70.9, 78.9) <0.001 22.3 (18.5, 26.6) <0.001
Kartuz 592 16.39 96.9 (93.9, 98.4) 65.2 (59.0, 70.9) 21.5 (18.0, 25.6)
Osh Tuzu 37 16.75 100.0 - 72.1 (62.9, 79.7) 17.8 (6.9, 38.9)
Extra 352 30.78 100.0 - 86.5 (81.8, 90.2) 70.1 (64.1, 75.5)
Extra Povarenok 8 39.85 100.0 - 91.6 (56.4, 98.9) 55.3 (21.4, 84.9)
Araltuz 293 17.06 98.6 (96.7, 99.4) 73.2 (68.2, 77.8) 15.7 (11.2, 21.7)
Nur 9 19.22 74.7 (33.7, 94.5) 61.9 (26.5, 88.0) 4.8 (0.6, 29.0)
Salamat 18 15.82 87.7 (57.4, 97.4) 70.1 (49.2, 85.0) 17.6 (8.3, 33.6)
Other 39 19.07 90.0 (72.0, 96.9) 72.2 (54.2, 85.1) 36.7 (21.4, 55.1)
TOTAL 2862 19.74 98.2 (97.3, 98.7) 75.6 (73.7, 77.5) 32.8 (30.4, 65.4)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Iodized salt: ≥ 5ppm; adequately iodized salt: ≥ 15ppm (international cut-off); adequately iodized salt: ≥ 25ppm (national cut-off)
b
All percentages except region-specific estimates are weighted for unequal probability of selection.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
Chi-square p-value <0.05 indicates that the proportion in at least one subgroup is statistically significantly different from
the values in the other subgroups

51
REPORT- OCTOBER 2022
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Figure 6. Proportion of households with adequate salt iodization (≥15 ppm), by region, the Kyrgyz Republic 2021

Bishkek city

Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city
Adequately iodized salt (%)
Osh oblast 50,0 - 60,0
60,0 - 70,0
Batken oblast 70,0 - 80,0
80,0 - 90,0
90,0 - 100,0

3.2.6. Bread and flour types and iron fortification

As shown in Table 16, almost all surveyed households consume bread and more than 60% consume home-
made bread. The most commonly purchased breads were white bread and flat bread.

Almost 96% of participating households had flour at home at the time of the survey. About half of the respondents
believed that the flour they used was fortified and about one-third of households were unsure about whether it
was fortified or not. More than 70% of surveyed households had flour in its original package, and the majority
of packages stated that the flour was fortified (see Table 17).

Table 16. Household bread consumption, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Household consumes bread
Yes 3032 99.2 (98.8, 99.5)
No 29 0.8 (0.5, 1.2)
Вид обычно употребляемого хлеба
Mainly purchased 1016 36.6 (33.8, 39.4)
Mainly homemade 2016 63.4 (60.6, 66.2)
Type of bread most commonly purchased c

White loaf/ white bread 426 46.3 (42.9, 49.8)

Rye bread 129 13.5 (11.3, 16.0)
Flat bread (Lepeshka) 433 37.4 (33.8, 41.2)
Wholegrain bread (Celnozernovoi) 13 1.4 (0.6, 3.0)
Other 11 1.2 (0.6, 2.5)
Don`t know 4 0.2 (0.1, 0.4)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Only includes households mainly purchasing bread

52
 REPORT- OCTOBER 2022

Table 17. Household wheat flour consumption, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Household had flour in household
Yes 2576 95.7 (94.6, 96.6)
No 104 4.3 (3.4, 5.4)
Household reports flour is fortified c,d

Yes 1388 55.5 (53.0, 58.1)

No 276 9.7 (8.5, 11.0)
Don’t know 912 34.8 (32.5, 37.2)
Packaging of floure
Original packaging stating flour is fortified 1168 48.2 (45.4, 51.1)
Original packaging without mention of fortification 595 25.0 (22.6, 27.6)
Undetermined, not in original package 601 23.6 (21.5, 25.9)
Undetermined for other reasons 97 3.2 (2.5, 4.1)
Most commonly used flour brands f

Akun 253 15.6 (13.7, 17.7)

Aliya 78 4.6 (3.6, 5.8)
Yashar 99 6.1 (4.5, 8.1)
Zhaksy 119 6.3 (5.1, 7.9)
Eldan 194 8.7 (7.5, 9.9)
Cesna 232 8.6 (7.4, 10.0)
Elnur 16 1.3 (0.7, 2.3)
Grain Ho 29 2.3 (1.3, 3.8)
Barakat 30 1.3 (0.8, 2.1)
Dani-Nan 38 1.5 (0.9, 2.5)
Dastarkh 46 2.9 (2.0, 4.3)
Dilnaz 43 3.4 (2.3, 5.0)
Makfa 16 1.0 (0.5, 1.9)
Mariyam 22 1.8 (1.1, 3.0)
Narodnay 20 1.3 (0.7, 2.4)
Nooruz 16 1.0 (0.5, 2.1)
Orion 19 1.4 (0.7, 3.0)
Pioneer 31 1.4 (0.9, 2.1)
Saryarqa 73 4.2 (2.9, 6.0)
Don't know 389 25.4 (22.7, 28.4)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages and means are weighted for unequal probability of selection between regions; for some sub-groups the percentages do
not add up to 100% because of a small proportion of the respondents that reported ‘don’t know’, which is not shown.
b
CI=confidence interval calculated taking into account the complex sampling design.
c
Results based on households that had flour in the house at the time of the survey.
d
This variable was calculated based on respondents’ perceptions about whether or not flour was fortified.
e
Results based on households that had flour in the house at the time of the survey and where interviewer was able to observe the flour
(N=2461).
f
Results exclude flour not in original package.

As shown in Table 18 and Figure 7, nearly one-quarter of the Kyrgyz Republic’s wheat flour is fortified, but
<2% was adequately fortified (i.e., iron EDTA ≥15ppm; ferrous sulfate or ferrous fumarate ≥60ppm). Regarding
fortified flour, significant differences were observed by residence, region, and wealth quintile, with higher

53
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

prevalences found in urban areas, Bishkek (see Figure 8), and higher wealth households, respectively. A
statistically significant association was also found between wheat flour fortification and household food security
status, with fortified flour consumed more by “mildly” food insecure households. Flour packaging, brand, and
country of origin were not significantly associated with the coverage of fortified flour, and no associations were
observed between the coverage of adequately fortified flour and the various subgroups.

Table 18. Proportion of households with fortified a and adequately a fortified flour, the Kyrgyz Republic 2021

Fortifieda Adequately fortifieda

Characteristic N
%b (95% CI))c P-valued %b (95% CI))c P-valued
Residence
Urban 299 32.1 (25.9, 38.9) <0.01 2.4 (1.1, 5.2) 0.404
Rural 405 19.5 (14.8, 25.2) 1.4 (0.5, 4.0)
Region
Batken oblast 69 21.5 (12.5, 34.5) <0.001 0.0 - 0.207
Jalal-Abad oblast 77 13.0 (5.1, 29.5) 2.6 (0.4, 16.2)
Issyk-Kul oblast 81 22.2 (14.9, 31.6) 3.7 (1.2, 10.5)
Naryn oblast 76 35.6 (22.0, 51.9) 4.0 (1.3, 11.2)
Osh oblast 86 29.1 (19.0, 41.9) 0.0 -
Talas oblast 69 6.1 (2.4, 14.8) 1.8 (0.2, 12.0)
Chui oblast 67 6.0 (1.8, 17.7) 0.0 -
Bishkek city 89 47.2 (35.1, 59.6) 3.4 (1.1, 10.0)
Osh city 90 34.4 (23.9, 46.8) 2.2 (0.6, 8.3)
Wealth quintile
Lowest 148 13.5 (8.0, 22.0) <0.01 0.9 (0.2, 3.6) 0.054
Second 140 23.2 (16.4, 31.7) 0.3 (0.0, 2.2)
Middle 148 20.3 (13.2, 30.0) 2.9 (0.8, 10.2)
Fourth 144 27.5 (20.2, 36.2) 0.5 (0.1, 2.1)
Highest 124 38.7 (27.3, 51.4) 4.1 (1.6, 10.2)
Household food security
Secure 487 26.6 (21.8, 32.0) <0.01 2.1 (1.0, 4.5) 0.531
Mildly insecure 70 30.6 (20.0, 43.6) 0.0 -
Moderately insecure 113 13.0 (7.7, 21.1) 1.1 (0.3, 4.5)
Severely insecure 34 12.2 (4.2, 30.7) 1.4 (0.2, 9.3)
Packaging of flour
Original packaging stating flour 300 23.1 (17.6, 29.6) 0.684 2.6 (1.0, 6.3) 0.370
is fortified
Original packaging without 163 28.4 (20.7, 37.6) 2.0 (0.8, 5.4)
mention of fortification
Undetermined, not in original 175 22.8 (16.2, 31.1) 0.5 (0.1, 2.0)
package
Undetermined for other rea- 27 24.3 (10.8, 45.8) 0.0 -
sons
Flour brand
Akun 61 34.0 (22.6, 47.7) 0.149 0.0 - 0.816
Aliya 20 28.1 (12.6, 51.3) 0.0 -
Yashar 23 41.4 (23.2, 62.4) 4.9 (0.7, 28.2)
Zhaksy 38 38.6 (23.1, 56.9) 6.6 (1.5, 24.4)

54
 REPORT- OCTOBER 2022

Eldan 42 15.2 (7.7, 28.0) 2.3 (0.3, 15.3)

Cesna 58 21.0 (10.5, 37.4) 7.4 (2.1, 22.6)
Elnur 2 0.0 - 0.0 -
Grain Ho 11 26.9 (9.8, 55.7) 0.0 -
Barakat 9 20.2 (5.4, 53.1) 0.0 -
Dani-Nan 15 8.6 (2.1, 29.4) 0.0 -
Dastarkh 14 39.9 (15.0, 71.4) 0.0 -
Dilnaz 7 29.2 (7.1, 69.0) 0.0 -
Makfa 4 62.0 (14.1, 94.2) 16.5
Mariyam 9 20.6 (4.2, 60.5) 0.0 -
Narodnay 4 11.0 (1.2, 56.3) 0.0 -
Nooruz 4 10.7 (1.4, 49.5) 0.0 -
Orion 7 0.0 - 0.0 -
Pioneer 8 0.0 - 0.0 -
Saryarqa 23 13.0 (4.8, 30.6) 3.5 (0.8, 13.9)
Don't know 104 21.1 (12.6, 33.1) 2.0 (0.5, 7.3)
Country of origin
The Kyrgyz Republic 148 29.6 (22.3, 38.1) 0.1992 1.3 (0.3, 5.6) 0.1385
Kazakhstan 207 22.7 (16.5, 30.4) 3.1 (1.4, 7.0)
Russia 4 62.0 (14.1, 94.2) 16.4 (1.9, 66.5)
Unknown 104 21.1 (12.6, 33.1) 2.0 (0.5, 7.3)
TOTAL 704 24.1 (20.2, 28.4) 1.7 (0.9, 3.4)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
Flour was collected in a sub-sample (25%) of participating households
a
Iron fortification: ≥ 5ppm NaFeEDTA or ≥ 10ppm iron fumarate/ sulfate; adequate: ≥ 15ppm NaFeEDTA or ≥ 60ppm iron fumarate/
sulfate
b
All percentages except region-specific estimates are weighted for unequal probability of selection between regions; for some sub-
groups the percentages do not add up to 100% because of a small proportion of the respondents that reported ‘don’t know’, which is
not shown.
c
CI=confidence interval calculated taking into account the complex sampling design
d
Chi-square p-value <0.05 indicates that the proportion in at least one subgroup is statistically significantly different from the values in
the other subgroups.

1,7%

22,3%
Adequately fortified

Inadequately fortified

Not fortified

76,0%

Figure 7. Flour fortification with iron by categories not fortified, inadequately fortified and adequately
fortified, the Kyrgyz Republic 2021

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Bishkek city

Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city
Fortified flour (%)
0,0 - 9,9
Osh oblast
10,0 - 19,9
Batken oblast 20,0 - 29,9
30,0 - 39,9
40,0 - 50,0

Figure 8. Proportion of households with fortified wheat flour, by region, the Kyrgyz Republic 2021

3.2.7. Covid-19 pandemic impact on participating households

As shown in Table 19, about one-third of households reported that household members have been infected with
COVID since the outbreak of the virus, with only about one-quarter of those who reported a COVID infection
also reporting that it was confirmed by a positive test result. For almost half of the households, COVID had a
negative impact on the income. About 15% of the households received assistance during the COVID outbreak,
most of them food.

Table 20 shows the effect of COVID 19 on food access and consumption. Though the majority of surveyed
households reported that costs of food have increased since the COVID outbreak, only about 25% of households
reported changing their eating behaviour during the pandemic. Moreover, less than one-third of households
reported any effects of COVID on food access, half of those stating that it is more difficult to buy foods from
local markets, mainly due to price increases.

Table19. Effect of the COVID-19 outbreak on participating households, the Kyrgyz Republic 2021

Characteristic N %a or mean (95% CI)b

Household member reported infected with COVID since start of the pandemic
Yes 947 31.5 (29.4, 33.8)
No 2057 66.1 (63.8, 68.3)
Don’t know 57 2.4 (1.8, 3.0)
Number of household members sick with COVID-19 c

Mean 947 2.0 (1.9, 2.1)

Number of household members with positive COVID-19 test с

Mean 947 0.5 (0.5, 0.6)

Proportion of individuals that reported being sick with COVID-19 infection that had received positive
COVID-19 testd
Mean proportion 900 27.6 (24.1, 31.1)
COVID-19 effects on household income
Income increased 241 7.3 (6.1, 8.7)
Income decreased 1303 44.3 (42.1, 46.5)

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 REPORT- OCTOBER 2022

No change of income 1484 47.0 (44.8, 49.3)

Don`t know 33 1.4 (0.9, 2.0)
Household received assistance during the pandemic
Yes 517 15.7 (13.7, 17.9)
No 2529 83.8 (81.6, 85.8)
Don’t know 15 0.5 (0.3, 0.9)
Type of assistance c

Money 16 3.2 (1.9, 5.2)

Food 484 94.9 (92.3, 96.6)
Hygiene/ protection kits 48 6.6 (5.0, 8.8)
Other 25 4.5 (3.0, 6.9)
Number of times food was received d

Mean 485 2.3 (1.3, 3.4)

Amount of food received was sufficient d

Yes 250 51.3 (46.1, 56.6)

No 225 46.1 (40.7, 51.7)
Don’t know 9 2.6 (1.4, 4.7)
Quality of food provided d

Good 237 47.9 (41.9, 53.9)

Average 189 41.0 (35.5, 46.6)
Poor 50 9.6 (6.9, 13.1)
Don’t know 8 1.6 (0.8, 3.5)
В домохозяйстве есть санитайзер для рук (наблюдение)
Yes 2414 78.7 (76.8, 80.6)
No 647 21.3 (19.4, 23.2)
TOTAL 3061
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Question only asked to households responding to previous question.
d
Households were excluded from this analysis if the number of individuals testing positive was greater than the number reporting a
COVID-19 infection.
e
Question only asked to households responding “Yes” to receiving assistance during the pandemic (n=517)

Table 20. Effect of COVID-19 on food access and consumption of participating households, the Kyrgyz
Republic 2021

Characteristic N %a (95% CI)b

Costs of food have increased since COVID-19 outbreak
Yes 2782 89.2 (87.8, 90.4)
No 235 9.3 (8.1, 10.6)
Don’t know 44 1.5 (1.1, 2.2)
Household’s eating behavior has changed because of COVID-19
Yes 818 24.4 (22.6, 26.4)
No 2179 73.4 (71.4, 75.3)
Don’t know 62 2.2 (1.6, 2.9)
Changes in household’s eating behaviour c

Eaten less variety of food 359 45.9 (41.4, 50.5)

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Eaten smaller quantity of food 289 34.9 (31.1, 38.8)

Eaten larger quantity of food 347 40.6 (36.4, 44.9)
Eaten foods of lower quality 140 19.5 (16.1, 23.3)
Other 135 12.8 (10.7, 15.3)
COVID-19 affects household food access
Yes 974 33.0 (30.7, 35.2)
No 2035 65.4 (63.1, 67.7)
Don’t know 52 1.7 (1.2, 2.4)
Effect of COVID-19 on food access c

Severely reduced 299 34.9 (30.5, 39.3)

Reduced 415 39.6 (35.6, 44.0)
Slightly reduced 253 25.0 (21.7, 28.7)
Increased 7 0.5 (0.2, 1.0)
More difficult to buy foods from local markets or shops since the onset of COVID
Yes 1684 51.7 (49.2, 54.2)
No 1353 47.5 (45.0, 50.0)
Don’t know 24 0.8 (0.5, 1.2)
Reasons for increased difficulty to buy foods from local markets or shops c

Markets/ shops closed 406 21.2 (18.7, 23.9)

Lack of stock in the markets 365 18.9 (16.5, 21.5)
Prices have gone up 1527 89.9 (87.9, 91.5)
Lack of transport/ cannot get to market 366 19.6 (17.0, 22.4)
Lack of cash for purchase 217 12.3 (10.5, 14.5)
Other 31 1.5 (0.9, 2.3)
Main foods less accessible d

Grains, cereals, tubers, roots 743 45.2 (42, 48.4)

Pulses 467 30.8 (27.8, 34)
Fruits 645 40.4 (37, 43.8)
Vegetables 619 38.8 (35.6, 42.0)
Eggs 485 31.9 (28.9, 35.2)
Milk, milk products 496 32.0 (28.9, 35.4)
Meat, poultry, meat products 983 61.2 (58.1, 64.2)
Fish, seafood 631 42.3 (39.1, 45.6)
Nuts 395 27.6 (24.7, 30.7)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total b/c of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Question only asked to households responding “Yes” to household’s eating behavior changing during pandemic
d
Question only asked to households responding to previous question

3.3. Children 6-59 month of age

3.3.1. Characteristics

Table 21 presents the demographic characteristics of children 6-59 months of age participating in the NIMAS.
These results show that the NIMAS survey population is similar to the actual Kyrgyz population based on the
2009 Census data. The sole exception is an underrepresentation in the survey of children 6-11 months of age
and children living in Bishkek.

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Table 21. Description of children 6-59 months of age, the Kyrgyz Republic 2021

Children in Kyrgyz
Characteristic N %a (95% CI)b
population [67]
Age Group (in months)
6-11 161 10.5 (9.0, 12.2) 19
12-23 331 21.5 (19.4, 23.8) 21
24-35 381 23.7 (21.4, 26.2) 21
36-47 350 22.3 (20.1, 24.6) 19
48-59 331 22.0 (20.0, 24.3) 19
Sex
Male 777 50.1 (47.3, 53.0) 51
Female 774 49.9 (47.0, 52.7) 49
Residence
Urban 572 28.9 (26.0, 32.0) 35
Rural 982 71.1 (68.0, 74.0) 65
Region
Batken oblast 191 8.9 (7.7, 10.2) 9
Jalal-Abad oblast 195 19.1 (16.5, 22.0) 19
Issyk-Kul oblast 134 6.8 (5.7, 8.1) 7
Naryn oblast 163 4.8 (4.1, 5.6) 4
Osh oblast 229 23.3 (20.5, 26.4) 22
Talas oblast 148 4.4 (3.7, 5.2) 4
Chui oblast 150 16.4 (13.7, 19.4) 14
Bishkek city 108 9.5 (7.6, 11.7) 16
Osh city 236 6.9 (5.8, 8.2) 6
Wealth quintile
Highest 338 20.2 (17.6, 22.9)
Second 370 26.0 (23.4, 28.8)
Middle 343 24.2 (21.3, 27.4)
Fourth 315 20.3 (17.3, 23.7)
Highest 180 9.4 (7.2, 12.1)
TOTAL 1554
Note: The N’s are un-weighted numbers in each subgroup. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.3.2. Recent illness and health indicators

Table 22 presents key birthweight and illness indicators. Regarding birthweight, nearly all children participating
in the survey had been weighed at birth, and low birthweight was rare among children 6-59 months of age.
About two-thirds of respondents provided their child’s birthweight from memory, with most of the remaining
birthweight measures coming directly from the child’s medical card. Regarding illness, the NIMAS found that
the proportion of children with acute lower respiratory infection is very low, but found that fever and diarrhea
are more common, each affecting approximately 14% and 8% of children, respectively. Despite relatively low
proportion of illness (self-reported), approximately one-third of surveyed children have elevated inflammation
markers.

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Table 22. Health indicators in children 6-59 months of age, the Kyrgyz Republic 2021

Characteristic N % or meana (95% CI)b

Child weighed at birth
Yes 1477 95.2 (93.3, 96.5)
No 7 0.5 (0.2, 1.3)
Don’t know 52 3.5 (2.4, 5.2)
Birthweight in kilograms (mean kg) c
1477 3.45 (3.39, 3.51)
Low birthweight c

<2500 grams 56 4.1 (3.0, 5.6)

2500+ grams 1386 95.9 (94.4, 97)
Birthweight source
Medical card 515 31.8 (28.9, 34.8)
Recall 920 67.8 (64.8, 70.6)
Other 7 0.4 (0.2, 1.2)
Had lower acute respiratory infection in past 2 weeks d

Yes 18 1.5 (0.8, 2.6)

No 1528 98.5 (97.4, 99.2)
Had diarrhea in past 2 weeks
Yes 124 8.1 (6.5, 10.2)
No 1411 91.1 (89.0, 92.8)
When child had diarrhea, ORS/zinc given e

Yes 17 18.3 (10.7, 29.5)

No 98 81.7 (70.5, 89.3)
Had fever in past 2 weeks
Yes 196 13.9 (11.7, 16.4)
No 1348 86.0 (83.5, 88.2)
Inflammationf
None 835 69.9 (66.8, 72.9)
Early (High CRP, Normal AGP) 38 3.0 (2.1, 4.3)
Acute (High CRP, High AGP) 105 9.2 (7.4, 11.5)
Convalescent (Normal CRP, High AGP) 183 17.8 (15.4, 20.5)
Note: The N’s are the numerators for a specific sub-group.
a
Percentages and means weighted for unequal probability of selection among regions. The percentages do not add up to 100% be-
cause the small proportion of the respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
b
CI=confidence interval calculated taking into account the complex sampling design.
c
Only includes those children weighed at birth
d
Questions on recent illness were phrased according to the MICS manual [68].
e
Only including respondents whose children had diarrhea in preceding 2 weeks.
f
For thresholds of inflammatory markers, refer to [69].

3.3.3. Infant and young child feeding indicators

Table 23 presents several of the standard infant and young child feeding indicators recommended by WHO and
UNICEF [28]. More than 95% of the surveyed children 6-23 months of age had ever been breastfed and more
than 90% of children were breastfed immediately after birth. The proportion of children exclusively breastfed
for the first two days after birth is high, and was practiced by 77% of women. While almost two-thirds of
children are fed with appropriate frequency, less than one-third of children had consumed 5 or more food
groups in the past 24 hours prior to the survey and only about 15% received a minimum acceptable diet.

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Table 23. IYCF indicators in children 6-23 months of age (unless stated otherwise), the Kyrgyz Republic 2021
Characteristic N %a (95% CI)b
Ever breastfed (Indicator #1)
Yes 476 96.9 (94.5, 98.2)
No 14 2.8 (1.5, 5.0)
Early initiation of breastfeeding (Indicator #2)
Yes 440 91.8 (88.6, 94.1)
No 33 7.7 (5.5, 10.6)
Exclusively breastfed for the first two days after birth (Indicator #3)
Yes 94 21.8 (17.9, 26.2)
No 378 77.1 (72.5, 81.2)
Continued breastfeeding at 1 year (12-23 months of age; Indicator #6)
Yes 162 50.0 (43.7, 56.2)
No 151 45.3 (39.2, 51.5)
Introduction of solid foods (6-8 months; Indicator #7)
Yes 88 74.5 (60.9, 84.6)
No 26 25.5 (15.4, 39.1)
Minimum dietary diversity (Indicator #8)
Yes 139 26.2 (21.8, 31.2)
No 350 73.8 (68.8, 78.2)
Minimum meal frequency (Indicator #9)
Yes 320 64.3 (59.2, 69.1)
No 171 35.7 (30.9, 40.8)
Minimum milk feeding frequency for non-breastfed children (Indicator #10)
Yes 93 53.7 (44.7, 62.6)
No 78 46.3 (37.4, 55.3)
Minimum acceptable diet (Indicator #11)
Yes 82 15.3 (11.8, 19.6)
No 407 84.7 (80.4, 88.2)
Egg and/or flesh food consumption (Indicator #12)
Yes 361 73.1 (68.6, 77.2)
No 129 26.9 (22.8, 31.4)
Sweet beverage consumption (Indicator #13)
Yes 336 70.0 (66.0, 73.8)
No 155 30.0 (26.2, 34.0)
Zero vegetable or fruit consumption (Indicator #15)
Zero vegetable or fruits 86 18.3 (15.0, 22.1)
Any vegetable or fruits 404 81.7 (77.9, 85.0)
Bottle fed in past 24 hours (WHO/UNICEF IYCF indicator #16)
Yes 245 50.0 (44.9, 55.1)
No 236 50.0 (44.9, 55.1)
Note: The N’s are the numerators for a specific sub-group. The percentages do not add up to 100% because the small proportion of
the respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.

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3.3.4. Dietary diversity in children 6-23 months of age

Table 24 presents the results of dietary diversity in children 6-23 months of age and shows that nationally one-
quarter of children have a minimum dietary diversity according to WHO’s guidelines. Statistically significant
differences were found by age group, residence, region, and household food security. Specifically, the proportion
of children with minimal dietary diversity increases with age and is highest in children 18-23 months of age.
Minimum dietary diversity is also significantly higher in rural children, and the lowest levels of minimum dietary
diversity were found in Bishkek and Chui, and the highest prevalences in Issyk-kul and Batken. Regarding food
security status, a dose-response relationship is observed, with the proportion of children achieving minimum
dietary diversity increasing as household food security status improves.

Table 24. Dietary diversity in children 6-23 months of age, the Kyrgyz Republic 2021
Consumed 5+ food groups
Characteristic Mean dietary score
N %a (95% CI)b p-valuec
Age Group (in months)
6-11 160 11.1 (6.9, 17.3) <0.001 3.6
12-17 179 29.6 (22.0, 38.5) 4.7
18-23 150 38.3 (29.8, 47.5) 5.2
Sex
Male 252 22.7 (17.3, 29.1) 0.077 4.5
Female 237 30.0 (24.0, 36.9) 4.5
Residence
Urban 178 18.2 (13.9, 23.4) <0.01 4.1
Rural 311 29.3 (23.4, 35.9) 4.6
Region
Batken oblast 46 36.8 (23.1, 53.0) <0.05 4.9
Jalal-Abad oblast 63 27.0 (17.3, 39.5) 4.7
Issyk-Kul oblast 43 39.1 (25.7, 54.5) 4.9
Naryn oblast 48 31.6 (20.4, 45.5) 4.8
Osh oblast 81 30.0 (19.0, 43.8) 4.3
Talas oblast 48 32.4 (18.6, 50.2) 4.8
Chui oblast 46 12.8 (5.9, 25.6) 4.3
Bishkek city 29 9.7 (3.0, 27.5) 3.7
Osh city 85 29.0 (21.9, 37.3) 4.4
Wealth quintile
Lowest 104 17.9 (11.0, 27.9) 0.060 4.3
Second 109 25.4 (17.9, 34.8) 4.5
Middle 114 35.8 (27.2, 45.3) 4.6
Fourth 100 25.3 (17.2, 35.6) 4.5
Highest 60 23.0 (13.7, 36.1) 4.2
Household food security
Secure 321 30.4 (24.3, 37.2) <0.05 4.6
Mildly insecure 48 23.5 (12.8, 3.09) 4.5
Moderately insecure 90 17.2 (10.4, 27.1) 4.2
Severely insecure 28 12.3 (5.0, 27.1) 3.9
TOTAL 489 26.2 (21.8, 31.2) 4.5
Note: The N’s are un-weighted numbers in each subgroup. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups

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3.3.5. Consumption of vitamins, minerals, supplements, and fortified foods

The consumption of vitamins, minerals, and supplements is presented in Table 25. A relatively small proportion
(<10%) of children 6-59 months of age consumed fortified infant formula or fortified baby cereal in the 24 hours
prior to the survey. About 10% of the surveyed children took iron tablets, and less than 20% took multivitamin
or vitamin D tablets in the past 6 months prior to the survey.

Table 25. Consumption of iron-fortified food, vitamin A and vitamin D supplements in children 6-59 months of
age, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Consumed commercially fortified baby cereal
Yes 134 8.2 (6.6, 10.3)
No 1370 88.5 (86.2, 90.5)
Consumed micronutrient powder
Yes 28 2.2 (1.4, 3.3)
No 1481 94.9 (92.9, 96.4)
Consumed infant formula with added iron
Yes 75 4.8 (3.5, 6.4)
No 1424 91.4 (89.1, 93.3)
Took iron tablets or syrup in past 6 months
Yes 145 9.6 (7.6, 11.9)
No 1385 89.2 (86.8, 91.3)
Took multivitamin supplements in past 6 months
Yes 260 17.5 (15.1, 20.2)
No 1269 81.4 (78.6, 83.9)
Took vitamin D tablets or syrup in past 6 months
Yes 273 17.1 (14.8, 19.7)
No 1264 82.5 (79.8, 84.8)
Is still taking vitamin D tablets or syrup c

Yes 108 39.9 (32.7, 47.6)

No 165 60.1 (52.4, 67.3)
Took fish oil supplements in past 6 months
Yes 102 7.0 (5.5, 8.8)
No 1428 91.9 (89.9, 93.5)
Is still taking fish oil supplements c

Yes 49 50.5 (39.4, 61.5)

No 48 49.5 (38.5, 60.6)
Took drug for intestinal worms
Yes 79 5.4 (4.1, 7.1)
No 1454 93.8 (92.0, 95.2)
Note: The N’s are the numerators for a specific sub-group. The percentages do not add up to 100% because the small proportion of
the respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Percentages weighted for unequal probability of selection among regions.

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3.3.6. COVID 19 and child feeding practices

Approximately 14% of caregivers received messages on IYCF in the context of COVID-19 (see Table 26). Very few
women stopped or did not start breastfeeding because of the pandemic, and less than 1% received donated
infant formula since the beginning of the pandemic. When asked to describe how their child’s feeding changed
during the pandemic, the majority of caregivers reported no change in the quantity or frequency of consumption
of the various food groups. However, of the caregivers that reported a change, most reported feeding their child
the different food groups at increased quantities or frequencies during the pandemic(see Table 26).

Table 26. Effect of COVID-19 pandemic on child feeding practices among children 6-59 months of age, the
Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Did caregiver receive message on IYCF in the context of COVID-19
Yes 273 13.7 (11.7, 16.0)
No 1191 79.2 (76.6, 81.6)
Stopped breastfeeding or did not start because of COVID pandemic
Yes 31 2.3 (1.5, 3.3)
No 1259 77.2 (74.4, 79.8)
Received donated infant formula since COVID pandemic started
Yes 9 0.6 (0.2, 1.5)
No 1520 98.5 (97.6, 99.1)
Increase or decrease of quantity or frequency of following foods
Infant formula, growing up milks
Change in quantity and/ or frequency 347 22.4 (19.7, 25.4)
No change 1199 77.6 (74.6, 80.3)
How did consumption change
Increase 318 92.7 (89.4, 95.1)
Decrease 25 7.3 (4.9, 10.6)
Sweetened drinks
Change in quantity and/ or frequency 499 31.5 (28.5, 34.7)
No change 1047 68.5 (65.3, 71.5)
How did consumption change
Increase 440 89.1 (85.3, 92.1)
Decrease 58 10.9 (7.9, 14.7)
Porridge or cereals-based food
Change in quantity and/ or frequency 545 35.6 (32.7, 38.7)
No change 1001 64.4 (61.3, 67.3)
How did consumption change
Increase 513 93.5 (90.8, 95.5)
Decrease 32 6.5 (4.5, 9.2)
Meat/fish/chicken or other meats
Change in quantity and/ or frequency 573 37.6 (34.5, 40.8)
No change 973 62.4 (59.2, 65.5)
How did consumption change
Increase 484 84.9 (80.2, 88.7)
Decrease 89 15.1 (11.3, 19.8)
Eggs

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 REPORT- OCTOBER 2022

Change in quantity and/ or frequency 505 32.2 (29.2, 35.4)

No change 1041 67.8 (64.6, 70.8)
How did consumption change
Increase 425 85.5 (81.0, 89.2)
Decrease 80 14.5 (10.8, 19.0)
Plant-based proteins such as lentils, beans, chickpeas
Change in quantity and/ or frequency 247 16.6 (14.0, 19.6)
No change 1299 83.4 (80.4, 86.0)
How did consumption change
Increase 195 86.2 (80.9, 90.2)
Decrease 42 13.8 (9.8, 19.1)
Fruits and vegetables
Change in quantity and/ or frequency 683 44.2 (40.8, 47.6)
No change 863 55.8 (52.4, 59.2)
How did consumption change
Increase 644 93.9 (91.3, 95.8)
Decrease 39 6.1 (4.2, 8.7)
Packaged sweet and salty foods
Change in quantity and/ or frequency 446 31.4 (28.2, 34.8)
No change 1100 68.6 (65.2, 71.8)
How did consumption change
Increase 360 81.5 (76.1, 85.9)
Decrease 85 18.5 (14.1, 23.9)
Note: The N’s are the numerators for a specific sub-group. The percentages do not add up to 100% because the small proportion of the
respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.3.7. Stunting

The national prevalence of stunting in the Kyrgyz Republic is 7% (Table 27) and is classified as “low” according
to WHO guidelines [70]. However, the prevalence is classified as “medium” (i.e., 10-19%) in several sub-
groups, including among children a) born with a low birthweight, b) living in Batken, c) residing in households
in the lowest wealth quintile, d) residing in severely food insecure households, e) residing in households with
inadequate sanitation, and f) residing in households with unsafe drinking water.

The prevalence of stunting significantly differs by wealth quintile and age. Children living in poor households
are more likely to be stunted than those living in wealthier households, and children aged 6-11 months are
less likely to be stunted than older children. Though not significant, children with low birth weight are twice
as likely to be stunted as children with normal birth weight. None of the other sub-group analyses yielded any
significant differences.

Figure 9 shows the distribution of the height-for-age z-score in the surveyed population of children 6-59
months of age, and shows that the z-score is shifted slightly towards the left of the standard growth curve.
Figure 10 shows the geographic distribution of child stunting prevalence by region. Of note, among the regions
only the stunting prevalence in Batken can classified as “medium” prevalence by WHO guidelines [70].

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20
Percent of children

15

10

0
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
Height-for-age Z score (HAZ)

WHO Growth standard Survey sample; SD=1.29

Figure 9. Distribution of height-for-age z-scores in children 6-59 months of age, the Kyrgyz Republic 2021

Bishkek city

Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city Stunting (%)

≤2,9
Osh oblast 3,0 - 5,9
6,0 - 8,9
Batken oblast
9,0 - 12,0
≥12,0

Figure 10. Prevalence of stunting by region, children 6-59 months, the Kyrgyz Republic 2021

Table 27. Percentage of children (6-59 months) with stunting, the Kyrgyz Republic 2021

Severe stuntingc Moderate stuntingd Any stuntinge

Characteristic N
%a (95% CI)b %a (95% CI)b %a (95% CI)b p-valuef
Age Group (in months)
6-11 143 0 (0, 0) 0 (0, 0) 0 (0, 0) <0.05
12-23 272 1.1 (0.5, 2.5) 7.9 (4.2, 14.6) 9.1 (5.1, 15.5)
24-35 325 1.2 (0.4, 3.7) 7.0 (4.5, 10.8) 8.2 (5.3, 12.3)
36-47 296 2.2 (1.0, 4.9) 5.8 (3.3, 10.0) 8.0 (5.1, 12.3)
48-59 279 1.1 (0.4, 3.4) 5.3 (3.3, 8.6) 6.5 (4.1, 9.9)

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 REPORT- OCTOBER 2022

Low birth weight

Yes 45 0 (0, 0) 14.3 (6.1, 30.1) 14.3 (6.1, 30.1) 0.062
No 1180 1.3 (0.7, 2.5) 5.1 (3.9, 6.7) 6.4 (5.0, 8.3)
Sex
Male 649 1.5 (0.8, 2.7) 5.7 (3.5, 9.0) 7.2 (4.8, 10.6) 0.864
Female 666 1 (0.4, 2.9) 5.9 (4.1, 8.4) 6.9 (5.0, 9.5)
Residence
Urban 482 0.8 (0.4, 1.8) 7.2 (3.7, 13.4) 8.0 (4.4, 14.1) 0.584
Rural 833 1.4 (0.7, 2.8) 5.2 (3.8, 7.2) 6.7 (5.0, 8.8)
Region
Batken oblast 172 1.1 (0.3, 4.5) 11.1 (7.0, 17.3) 12.3 (7.9, 18.7) 0.471
Jalal-Abad oblast 174 2.3 (0.9, 5.5) 3.9 (2.0, 7.3) 6.1 (3.3, 11.1)
Issyk-Kul oblast 120 3.1 (0.8, 12.0) 3.1 (0.9, 10.1) 6.2 (2.6, 14.2)
Naryn oblast 152 2.1 (0.7, 5.8) 5.2 (2.3, 11.3) 7.3 (4.2, 12.5)
Osh oblast 191 1.2 (0.2, 5.8) 7.9 (4.6, 13.2) 9.1 (5.6, 14.4)
Talas oblast 120 0 (0, 0) 4.0 (1.7, 9.3) 4.0 (1.7, 9.3)
Chui oblast 86 0 (0, 0) 2.9 (0.4, 19.0) 2.9 (0.4, 19.0)
Bishkek city 93 0 (0, 0) 6.4 (1.5, 23.1) 6.4 (1.5, 23.1)
Osh city 207 1.6 (0.7, 3.9) 6.6 (3.7, 11.5) 8.2 (4.6, 14.3)
Wealth quintile
Lowest 317 3.6 (1.7, 7.3) 8.1 (4.7, 13.4) 11.6 (7.7, 17.2) <0.05
Second 301 1.0 (0.3, 3.0) 6.7 (4.3, 10.3) 7.7 (5.1, 11.4)
Middle 286 0.4 (0.1, 1.9) 3.0 (1.5, 5.9) 3.5 (1.9, 6.3)
Fourth 258 1.0 (0.2, 4.1) 5.8 (3.4, 9.7) 6.8 (4.1, 11.0)
Highest 146 0.4 (0.1, 2.8) 3.1 (0.8, 11.6) 3.5 (1.0, 12.0)
Household food security
Secure 870 1.3 (0.6, 2.6) 6.3 (4.7, 8.4) 7.6 (5.7, 10.0) 0.469
Mildly insecure 141 0.4 (0.1, 2.7) 2.1 (0.8, 5.2) 2.5 (1.1, 5.6)
Moderately insecure 230 1.1 (0.3, 3.9) 5.9 (2.3, 14.3) 7.0 (3.1, 15.1)
Severely insecure 67 2.6 (0.4, 16.8) 7.4 (1.1, 37.6) 10.1 (2.2, 35.7)
Household sanitationg
Unadequate 199 2.0 (0.7, 6.0) 8.2 (5.0, 13.3) 10.2 (6.5, 15.8) 0.303
Adequate 1106 1.3 (0.6, 2.6) 5.2 (3.8, 7.1) 6.5 (4.9, 8.5)
Safe drinking water h

Yes 1265 1.1 (0.6, 2.1) 5.8 (4.4, 7.5) 6.9 (5.4, 8.8) 0.558
No 30 5.4 (1.2, 20.6) 4.8 (0.9, 22.5) 10.2 (4.0, 23.4)
TOTAL 1315 1.2 (0.7, 2.2) 5.8 (4.3, 7.8) 7.0 (5.4, 9.2)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Severe stunting represents children who are below -3 standard deviations (SD; z-scores) from the WHO Child Growth Standards
population median.
d
Moderate stunting includes children who are equal to or above -3 standard deviations (SD) and below-2 SD from the WHO Child
Growth Standards population median.
e
Any stunting includes both severely and moderately stunted children.
f
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups. Results
are based on any stunting.
g
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation= open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field.
h
Composite variable of main source of drinking water and treating water to make safe for drinking

67
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.3.8. Wasting, overweight and obesity

Less than 1% of children 6-59 months of age in the Kyrgyz Republic are wasted. This prevalence can be
classified as “very low” according to WHO classification [70]. Most of the wasted children suffer from moderate
acute malnutrition; severe acute malnutrition is rare (Table 28).

The survey found significant differences in wasting by residence, region, and household food security status.
Children living in urban areas are more likely to be wasted compared to children in rural areas. Among the
regions, wasting was significantly higher in Naryn, and accounted for the majority of wasting cases. In addition,
the highest prevalence of wasting was found in children living in mildly food insecure households. No significant
differences were detected by age, low birth weight, sex, household wealth quintile, household sanitation and
household access to safe drinking water.

25

20
Percent of children

15

10

0
-5 -4 -3 -2 -1 0 1 2 3 4 5
Weight-for-height Z score (WAZ)
WHO Growth standard Survey sample; SD=1.29

Figure 11. Distribution of weight-for-height z-scores in children 6-59 months of age, the Kyrgyz Republic
2021

Figure 11 shows the distribution of the height-for-age z-score in the surveyed population of children 6-59
months of age. It shows that the distribution is slightly shifted towards the right of the standard growth curve,
indicating that weight-for-height z-scores were on average higher than those in the WHO Growth Standard
population.

Table 28. Percentage of children (6-59 months) with wasting, the Kyrgyz Republic 2021

Severe stuntingc Moderate stunting d Any stuntinge

Characteristic N
%a (95% CI)b %a (95% CI)b %a (95% CI)b p-valuef
Age Group (in months)
6-11 143 0.3 (0, 2.2) 0.3 (0, 1.9) 0.6 (0.2, 1.8) 0.366
12-23 274 0.1 (0, 0.9) 1.5 (0.3, 8.0) 1.6 (0.3, 7.7)
24-35 321 0 (0, 0) 0.8 (0.2, 3.2) 0.8 (0.2, 3.2)
36-47 294 0.6 (0.3, 1.4) 0.2 (0, 1.1) 0.8 (0.3, 1.8)
48-59 275 0 (0, 0) 0 (0, 0) 0 (0, 0)
Low birth weight
Yes 45 0 (0, 0) 1.5 (0.2, 10.1) 1.5 (0.2, 10.1) 0.377
No 1172 0.2 (0.1, 0.5) 0.4 (0.1, 1.1) 0.6 (0.3, 1.3)

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 REPORT- OCTOBER 2022

Sex
Male 646 0.2 (0.1, 0.6) 0.3 (0.1, 0.6) 0.5 (0.2, 1.0) 0.212
Female 661 0.2 (0.1, 0.7) 0.9 (0.2, 3.4) 1.1 (0.4, 3.3)
Residence
Urban 480 0.7 (0.3, 1.5) 1.3 (0.3, 5.7) 2.0 (0.7, 5.5) <0.01
Rural 827 0 (0, 0) 0.3 (0.1, 1.0) 0.3 (0.1, 1.0)
Region
Batken oblast 170 0 (0, 0) 0.5 (0.1, 3.7) 0.5 (0.1, 3.7) <0.05
Jalal-Abad oblast 173 0 (0, 0) 0.6 (0.1, 4.4) 0.6 (0.1, 4.4)
Issyk-Kul oblast 119 0.7 (0.1, 5.1) 0 (0, 0) 0.7 (0.1, 5.1)
Naryn oblast 153 3.3 (1.5, 7.2) 2.5 (1.2, 5.2) 5.8 (3.1, 10.6)
Osh oblast 190 0 (0, 0) 0 (0, 0) 0 (0, 0)
Talas oblast 118 0 (0, 0) 0 (0, 0) 0 (0, 0)
Chui oblast 87 0 (0, 0) 1.8 (0.2, 12.1) 1.8 (0.2, 12.1)
Bishkek city 91 0 (0, 0) 0 (0, 0) 0 (0, 0)
Osh city 206 0 (0, 0) 0 (0, 0) 0 (0, 0)
Wealth quintile
Lowest 313 0 (0, 0) 0.5 (0.1, 3.8) 0.5 (0.1, 3.8) 0.871
Second 300 0.3 (0, 1.9) 0.1 (0, 1.0) 0.4 (0.1, 1.4)
Middle 285 0.4 (0.1, 1.7) 0.4 (0.1, 1.6) 0.8 (0.3, 2.2)
Fourth 258 0.2 (0, 1.5) 0.8 (0.2, 4.2) 1.1 (0.3, 4.0)
Highest 144 0.5 (0.1, 3.2) 0.5 (0.1, 3.2) 0.9 (0.1, 6.4)
Household food security
Secure 864 0.2 (0.1, 0.6) 0.3 (0.1, 1.1) 0.6 (0.2, 1.3) <0.05
Mildly insecure 141 0.6 (0.1, 4.4) 2.9 (0.5, 14.7) 3.6 (0.8, 14.4)
Moderately insecure 229 0 (0, 0) 0 (0, 0) 0 (0, 0)
Severely insecure 66 0 (0, 0) 0.5 (0.1, 3.5) 0.5 (0.1, 3.5)
Household sanitation g

Unadequate 197 0.3 (0, 1.8) 0.7 (0.1, 5.1) 1.0 (0.2, 4.6) 0.932
Adequate 1100 0.2 (0.1, 0.5) 0.4 (0.2, 1.0) 0.6 (0.3, 1.2)
Safe drinking waterh
Yes 1257 0.3 (0.1, 0.5) 0.5 (0.2, 1.1) 0.7 (0.4, 1.4) 0.926
No 30 0 (0, 0) 0 (0, 0) 0 (0, 0)
TOTAL 1307 0.2 (0.1, 0.4) 0.6 (0.2, 1.7) 0.8 (0.3, 1.8)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Severe wasting represents children who are below -3 standard deviations (SD; z-scores) from the WHO Child Growth Standards
population median
d
Moderate wasting includes children who are equal to or above -3 standard deviations (SD) and below-2 SD from the WHO Child
Growth Standards population median
e
Any wasting includes both severely and moderately wasted children
f
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups. Results
are based on any wasting.
g
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation= open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
h
Composite variable of main source of drinking water and treating water to make safe for drinking

69
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Overweight and obesity affects approximately 7% of Kyrgyz children aged 6-59 months, and the overweight
prevalence is classified as “medium” by WHO thresholds [70]. Significant differences were found by the age
group, birthweight status, and region. Regarding age group, children 6-11 months of age have the highest
overnutrition prevalence, and the prevalence declines, albeit not consistently, as age increases. Children with
low birthweight are less likely to be overweight or obese compared to those with normal birth weight. Further,
significant differences were detected by region, with highest prevalences in Naryn and Osh oblast and lowest
in Chui and Bishkek. No significant differences were detected by sex, wealth quintile, household food security,
household sanitation, access to safe drinking water, and inflammation.

Table 29. Prevalence of overweight and obesity in children 6-59 months of age, by various demographic
characteristics, the Kyrgyz Republic 2021

Overweightd Obesed Overweight or obesityd

Characteristic N
%a (95% CI)b % (95% CI)b % (95% CI)b p-valuec
Age Group (in months)
6-11 143 14.5 (9.3, 21.9) 2.1 (0.5, 7.7) 16.5 (10.9, 24.4) <0.005
12-23 274 6.1 (3.6, 10.1) 0.6 (0.2, 1.9) 6.7 (4.1, 10.7)
24-35 321 7.6 (4.9, 11.6) 0.9 (0.2, 3.2) 8.5 (5.5, 12.8)
36-47 294 5.0 (2.4, 10.1) 0 (0, 0) 5.0 (2.4, 10.1)
48-59 275 3.6 (1.8, 7.2) 0.9 (0.2, 3.3) 4.5 (2.4, 8.2)
Low birth weight
Yes 45 0.8 (0.1, 5.6) 0 (0, 0) 0.8 (0.1, 5.6) <0.01
No 1172 6.7 (5.2, 8.5) 0.7 (0.4, 1.4) 7.4 (5.8, 9.4)
Sex
Male 646 6.6 (4.7, 9.3) 1.0 (0.5, 2.1) 7.6 (5.5, 10.4) 0.719
Female 661 6.5 (4.7, 8.8) 0.5 (0.2, 1.8) 7.0 (5.0, 9.6)
Residence
Urban 480 5.0 (3.3, 7.7) 0.6 (0.2, 1.7) 5.6 (3.9, 8.2) 0.143
Rural 827 7.1 (5.4, 9.3) 0.8 (0.4, 1.7) 8.0 (6.0, 10.4)
Region
Batken oblast 170 5.0 (2.6, 9.4) 1.2 (0.3, 4.5) 6.2 (3.4, 10.9) <0.05
Jalal-Abad oblast 173 7.0 (4.2, 11.5) 0 (0, 0) 7.0 (4.2, 11.5)
Issyk-Kul oblast 119 4.1 (1.9, 8.7) 0.9 (0.1, 5.9) 5.0 (2.6, 9.4)
Naryn oblast 153 9.0 (4.2, 18.0) 2.1 (0.7, 5.8) 11.0 (5.9, 19.7)
Osh oblast 190 10.7 (7.5, 15.1) 1.8 (0.7, 4.7) 12.6 (8.5, 18.2)
Talas oblast 118 6.6 (2.5, 16.2) 0.7 (0.1, 5.1) 7.3 (3.1, 16.4)
Chui oblast 87 3.5 (0.8, 13.3) 0 (0, 0) 3.5 (0.8, 13.3)
Bishkek city 91 3.8 (1.6, 8.6) 0 (0, 0) 3.8 (1.6, 8.6)
Osh city 206 4.2 (2.2, 7.8) 0.4 (0.1, 2.6) 4.6 (2.6, 8.1)
Wealth quintile
Lowest 313 6.9 (4.4, 10.7) 1.7 (0.7, 4.2) 8.6 (5.5, 13.1) 0.383
Second 300 5.6 (3.5, 9.0) 0.5 (0.2, 1.6) 6.1 (3.9, 9.5)
Middle 285 8.6 (5.4, 13.5) 1.1 (0.3, 3.6) 9.7 (6.0, 15.5)
Fourth 258 4.9 (2.1, 11.0) 0 (0, 0) 4.9 (2.1, 11.0)
Highest 144 6.8 (3.7, 12.0) 0 (0, 0) 6.8 (3.7, 12.0)
Household food security
Secure 864 6.4 (4.8, 8.5) 0.7 (0.3, 1.6) 7.1 (5.3, 9.4) 0.764
Mildly insecure 141 9.8 (4.4, 20.5) 0.4 (0.1, 2.7) 10.2 (4.7, 20.7)

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 REPORT- OCTOBER 2022

Moderately insecure 229 5.3 (3.0, 9.1) 1.5 (0.4, 4.7) 6.7 (3.7, 11.8)
Severely insecure 66 6.5 (2.2, 17.3) 0.5 (0.1, 3.8) 7.0 (2.6, 17.6)
Household sanitationHousehold sanitatione
Unadequate 197 3.9 (1.9, 8.0) 0.3 (0, 2.2) 4.2 (2.0, 8.6) 0.305
Adequate 1100 7.1 (5.5, 9.1) 0.8 (0.4, 1.6) 8.0 (6.2, 10.1)
Safe drinking water f

Yes 1257 6.7 (5.3, 8.5) 0.8 (0.4, 1.5) 7.5 (5.9, 9.5) 0.723
No 30 4.5 (0.5, 28.5) 0 (0, 0) 4.5 (0.5, 28.5)
Inflammationg
Yes 323 8.2 (5.6, 12.0) 0.3 (0.1, 1.2) 8.5 (5.9, 12.3) 0.276
No 815 5.5 (3.9, 7.8) 1.0 (0.5, 2.1) 6.5 (4.6, 9.0)
TOTAL 1307 6.5 (5.2, 8.2) 0.8 (0.4, 1.4) 7.3 (5.8, 9.2)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
P-value <0.05 indicates that at least one subgroup is significantly different from the others.
d
Overweight is defined as having a weight-for-height z-score greater than +2 but less than or equal to +3 standard deviations from the
WHO Child Growth Standards population median; obesity is defined as having a weight-for-height z-score greater than +3 standard
deviations from the WHO Child Growth Standards population median.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking

3.3.9. Underweight

Only 0.7% (95% CI: 0.4, 1.2; N= 1319) of children 6-59 months of age are underweight and no significant
differences were detected in any of the sub-group analyses. Due to the small number of children found with
underweight, results by sub-group are not displayed.

3.3.10. Microcephaly

Nationally, 1.3% of children 6-59 months of age have microcephaly. Microcephaly is significantly associated
with stunting, wasting, and underweight. Moreover, significant differences were found by region, with highest
prevalence in Naryn and lowest in Jalal-Abad and Chui. No significant differences were found for age, low birth
weight, sex, residence, household wealth quintile, food security, sanitation and access to safe drinking water.
Due to the small number of children found with microcephaly results by sub-group are not displayed.

3.3.11. Anemia, iron deficiency, and iron deficiency anemia

About 21% of children 6-59 months of age are anemic (Table 30). A small proportion (0.2%) of child anemia is
classified as severe, and ~7% and ~14% of children have moderate and mild anemia, respectively (see appendix
2, Table 89). According to WHO, anemia in children can be considered a moderate public health problem [36].
The distribution of hemoglobin values for children is shown in Figure 12. It is roughly symmetric with the
majority of values above the cut-off point of 110 g/L. Median hemoglobin concentration among all children 6-59
months old is 119 g/L.

The highest anemia prevalence occurs in children 6-11 months of age and the prevalence decreases with
age. The prevalence of anemia is significantly higher in rural areas than in urban centers. Further, significant
differences were detected by region, with the highest anemia prevalences found in Issyk Kul and Naryn, and
the lowest prevalences found in Bishkek and Osh City. Moreover, significant differences were found by wealth
quintile and household sanitation. Children living in poorest households have the highest anemia prevalence,
and those residing in the wealthiest households have the lowest anemia prevalence. Other variables, such as
sex, low birth weight, household food security and access to safe drinking water are not significantly associated
with anemia with statistical significance.

71
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

20
Percent of children

15

10

0
50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200
Hemoglobin concentration (g/L)
Median: 119 g/L Survey sample

Figure 12. Distribution of adjusted hemoglobin (g/L) in children 6-59 months of age, the Kyrgyz Republic 2021

In children 6-59 months of age, the ID prevalence is more than double the anemia prevalence (Table 30). Only
age group is significantly associated with ID prevalence, with the highest prevalence found in children 12-23
months of age. Figure 13 illustrates the overlap between anemia and ID in children 6-59 months of age, and
shows that about three-quarters of the children who have anemia also have ID.

Similar to ID, the highest prevalence of iron deficiency anemia (IDA) was found in children 12-23 months of
age. IDA is significantly associated with urban/rural residence, region, wealth quintile, household food security
and household sanitation. Children living in rural areas are more likely to have IDA compared to those in
urban centers. The largest proportion of children with IDA was found in Chui and the smallest in Jalal Abad.
Moreover, children residing in the poorest and severely food insecure households are the most affected by IDA.
Surprisingly, the prevalence of IDA is higher in children living in households with adequate sanitation compared
to those with inadequate sanitation. Other demographic variables investigated here are not significantly
associated with IDA.

15% 33%
anemia only 6% iron iron
deficiency deficiency
anemia only

Figure 13. Диаграмма Венна, показывающая одновременное наличие анемии и Deficientа железа у детей
в возрасте 6-59 месяцев, Kyrgyzская Республика, 2021 год

72
 Table 30. Prevalence of anemia, iron deficiency, and iron deficiency anemia in children 6-59 months of age, by various demographic characteristics, the Kyrgyz
Republic 2021.

Anemia Iron deficiencye Iron deficiency anemia

Characteristic c d a c d
N % a, b 95% CI p-value N % 95% CI p-value N % a, f 95% CIc p-valued
Age Group (in months)
6-11 120 36.9 (26.9, 48.2) <0.001 99 39.7 (27.8, 52.9) <0.001 99 14.5 (7.2, 27.2) <0.001
12-23 240 36.4 (28.5, 45.0) 234 59.4 (51.6, 66.7) 226 28.9 (21.1, 38.3)
24-35 302 22.6 (17.8, 28.3) 287 55.4 (48.8, 61.8) 284 16.7 (12.2, 22.3)
36-47 283 12.7 (7.9, 19.7) 274 42.3 (34.7, 50.3) 272 10.4 (6.1, 17.1)
48-59 265 7.4 (4.6, 11.6) 262 36.9 (30.5, 43.7) 259 6.0 (3.5, 10.0)
Low birth weight
Yes 40 27.6 (14.4, 46.2) 0.819 40 53.4 (36.9, 69.2) 0.528 38 24.3 (11.8, 43.5) 0.145
No 1084 20.4 (17.3, 23.8) 1032 47.8 (43.8, 51.9) 1019 14.7 (12.0, 18.0)
Sex
Male 593 20.7 (16.7, 25.3) 0.895 569 48.8 (44.3, 53.3) 0.331 562 15.8 (12.3, 20.1) 0.551
Female 614 21.1 (16.7, 26.2) 584 46.0 (41.1, 50.9) 575 14.2 (10.5, 19.0)
Residence
Urban 452 14.1 (10.4, 18.7) <0.005 427 42.7 (36.4, 49.3) 0.148 421 10.3 (7.0, 15.0) <0.05
Rural 759 23.8 (19.7, 28.3) 734 48.6 (44.1, 53.2) 720 16.8 (13.2, 21.1)
Region
Batken oblast 172 19.9 (13.2, 28.9) <0.001 172 47.4 (40.1, 54.8) 0.476 172 17.6 (12.0, 25.1) <0.001
Jalal-Abad oblast 164 11.0 (7.0, 16.9) 162 46.4 (37.0, 56.1) 160 6.0 (3.2, 11.0)
Issyk-Kul oblast 118 33.9 (23.8, 45.8) 120 44.9 (33.9, 56.4) 118 21.5 (14.8, 30.2)
Naryn oblast 141 32.7 (23.9, 43.0) 140 59.8 (47.5, 71.0) 139 20.6 (12.2, 32.8)
Osh oblast 140 22.2 (14.5, 32.4) 147 45.4 (37.8, 53.2) 137 14.2 (8.2, 23.5)
Talas oblast 120 33.1 (24.7, 42.8) 86 48.3 (34.8, 62.1) 86 14.9 (8.9, 23.9)
Chui oblast 76 29.2 (18.5, 42.8) 77 51.0 (39.0, 63.0) 75 27.3 (16.8, 41.2)
Bishkek city 90 10.8 (5.9, 19.1) 73 48.0 (36.9, 59.3) 72 8.5 (3.8, 17.9)
Osh city 190 11.6 (6.7, 19.6) 184 35.4 (27.1, 44.8) 182 6.9 (3.6, 12.9)
Wealth quintile
Lowest 292 27.6 (20.6, 36.0) <0.05 273 54.2 (46.7, 61.5) 0.144 268 23.4 (16.3, 32.5) <0.01

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74
Second 275 17.4 (12.7, 23.2) 268 47.0 (40.0, 54.2) 262 10.8 (7.3, 15.7)
Middle 270 23.2 (17.7, 29.8) 270 45.2 (37.3, 53.4) 264 16.5 (11.3, 23.5)
Fourth 232 17.9 (12.8, 24.6) 222 45.8 (37.0, 54.7) 220 11.2 (6.9, 17.8)
Highest 137 14.2 (8.3, 23.3) 124 35.0 (25.1, 46.4) 123 10.4 (5.7, 18.3)
Food secure
Secure 799 18.6 (15.2, 22.6) 0.167 775 45.6 (40.6, 50.6) 0.330 765 12.1 (9.3, 15.6) <0.05
Mildly insecure 134 21.6 (13.3, 33.2) 122 41.6 (30.6, 53.6) 121 15.6 (8.2, 27.7)
Moderately insecure 212 24.5 (18.2, 32.2) 206 52.6 (43.6, 61.5) 199 21.0 (14.6, 29.2)
Severely insecure 61 34.2 (16.8, 57.2) 54 55.1 (38.9, 70.3) 52 32.5 (13.8, 59.2)
g
Household sanitation
Unadequate 187 12.0 (7.2, 19.4) <0.05 178 43.1 (34.3, 52.4) 0.387 176 6.3 (3.3, 11.7) <0.005
Adequate 1017 22.6 (19.1, 26.6) 978 47.6 (43.7, 51.5) 960 16.7 (13.4, 20.5)
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

h
Safe drinking water
Yes 1165 21.2 (18.0, 24.8) 0.493 1126 46.9 (43.1, 50.7) 0.783 1106 15.1 (12.2, 18.5) 0.871
No 30 17.2 (8.8, 31.0) 30 47.9 (25.5, 71.2) 30 13.4 (5.5, 29.1)
TOTAL 1211 20.9 (17.8, 24.4) 1161 47.0 (43.3, 50.7) 1141 15.0 (12.1, 18.3)
Note: The N’s are the denominators for a specific sub-group. For iron deficiency and iron deficiency anemia, the numbers are smaller than for anemia due to unsuccessful blood collection (sufficient
blood could be obtained only for the on-site analysis of hemoglobin concentration).
a
Percentages weighted for unequal probability of selection.
b
Anemia defined as hemoglobin < 110 g/L adjusted for altitude.
c
CI=confidence interval calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
f
Iron deficiency defined as plasma ferritin < 12 µg/L, ferritin adjusted for inflammation [41].
g
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
hold. Inadequate sanitation = open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field
h
Composite variable of main source of drinking water and treating water to make safe for drinking
 REPORT- OCTOBER 2022

3.3.12. Vitamin A deficiency

The prevalence of vitamin A deficiency in Kyrgyz children 6-59 months of age would be classified as moderate by
WHO [71], see Table 31. The prevalence is significantly higher in male children than in females and significantly
differs by region. In Bishkek, more than 20% of children suffer from vitamin A deficiency and vitamin A deficiency
can be considered a severe public health problem there. Moreover, with just over 19% deficiency prevalence in
Osh Oblast and Osh City vitamin A deficiency is close to severe in those regions. Meanwhile, the prevalence of
vitamin A deficiency in Issyk Kul and Naryn is below 5%.
Vitamin A deficiency does not differ by child age, household wealth, urban/rural residence, or household food
security status.

Table 31. Prevalence of vitamin A deficiency in children 6-59 months, by various demographic characteristics,
the Kyrgyz Republic 2021
Characteristic N %a with VADb (95% CI))c p-valued
Age Group (in months)
6-11 99 14.3 (7.3, 26.2) 0.735
12-23 234 11.8 (7.8, 17.5)
24-35 287 14.2 (10.1, 19.5)
36-47 274 14.6 (9.9, 21.1)
48-59 262 17.3 (11.8, 24.8)
Sex
Male 569 17.2 (13.6, 21.5) <0.05
Female 584 12.0 (9.1, 15.5)
Residence
Urban 427 18.8 (13.6, 25.4) 0.094
Rural 734 13.5 (10.8, 16.8)
Region
Batken oblast 172 18.0 (12.2, 25.9) <0.05
Jalal-Abad oblast 162 12.4 (8.1, 18.7)
Issyk-Kul oblast 120 3.6 (1.3, 9.5)
Naryn oblast 140 4.4 (1.9, 9.9)
Osh oblast 147 19.3 (13.5, 26.8)
Talas oblast 86 10.1 (4.9, 19.7)
Chui oblast 77 14.4 (7.9, 24.9)
Bishkek city 73 21.0 (10.3, 38.2)
Osh city 184 19.5 (14.1, 26.4)
Wealth quintile
Lowest 273 15.4 (10.4, 22.3) 0.806
Second 268 16.6 (11.6, 23.1))
Middle 270 13.0 (8.7, 18.9)
Fourth 222 13.1 (8.1, 20.4)
Highest 124 18.6 (8.8, 35.2)
TOTAL 1161 15.0 (12.5, 17.9)
Note: The N’s are the denominators for a specific sub-group; for VAD, the numbers are smaller than for anemia due to unsuccessful
blood collection (sufficient blood could be obtained only for the on-site analysis of hemoglobin concentration) or insufficient sample
volumes for retinol binding protein analysis.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
VAD = Vitamin A deficiency, defined as RBP adjusted for inflammation [42] <0.569 umol/L.
c
CI=confidence interval calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.3.13. Vitamin D deficiency

Vitamin D was measured in a 25% sub-sample of children aged 6-59 months. About one- quarter of children
are vitamin D deficient or insufficient. Deficiency or insufficiency consistently decrease with the child’s age.
Moreover, a much larger proportion of children in the wealthiest households are affected by deficiency or
insufficiency compared to children living in households of the other wealth quintiles. Other demographic
variables investigated here are not significantly associated with vitamin D deficiency or insufficiency.

Table 32. Prevalence of vitamin D deficiency in children 6-59 months of age, by various demographic
characteristics, the Kyrgyz Republic 2021

Deficienta Insufficienta Deficient or insufficient

Characteristic Nb
% c
(95% CI) d
% c
(95% CI) d
%c (95% CI)d p-valuee
Age Group (in months)
6-11 34 15.8 (6.0, 35.5) 32.9 (16.6, 54.7) 48.7 (30.1, 67.6) <0.05
12-23 68 3.1 (1.3, 7.1) 29.6 (17.9, 44.7) 32.6 (20.6, 47.5)
24-35 99 7.3 (2.7, 18.0) 18.3 (10.8, 29.3) 25.6 (16.1, 38.1)
36-47 99 3.1 (1.3, 7.1) 15.6 (9.1, 25.6) 18.7 (11.7, 28.7)
48-59 90 3.2 (1.1, 9.0) 12.3 (7.0, 20.7) 15.5 (8.8, 25.9)
Sex
Male 189 4.5 (2.3, 8.5) 16.5 (11.1, 23.7) 21.0 (14.8, 28.9) 0.267
Female 201 5.6 (2.9, 10.7) 21.5 (15.3, 29.5) 27.2 (19.8, 36.1)
Residence
Urban 158 5.8 (3.2, 10.2) 30.1 (20.6, 41.6) 35.9 (26.2, 47.0) 0.05
Rural 236 4.7 (2.5, 8.6) 16.6 (12.3, 21.9) 21.2 (15.7, 28.1)
Wealth quintile
Lowest 83 6.1 (2.5, 14.0) 17.9 (10.4, 29.1) 23.9 (14.5, 36.9) <0.01
Second 96 2.1 (0.8, 5.2) 26.1 (17.6, 36.8) 28.1 (19.5, 38.8)
Middle 92 5.2 (1.9, 13.1) 7.8 (3.8, 15.1) 12.9 (7.2, 22.2)
Fourth 71 4.4 (1.1, 16.7) 22.4 (12.9, 36.0) 26.8 (16.5, 40.5)
Highest 48 7.9 (2.6, 21.6) 43.7 (22.9, 67.0) 51.6 (30.1, 72.6)
Household food security
Secure 241 17.9 (12.7, 24.6) 5.1 (2.7, 9.3) 23.0 (16.7, 30.9) 0.637
Mildly insecure 44 27.1 (15.8, 42.6) 6 (1.6, 19.8) 33.2 (20.5, 48.8)
Moderately insecure 89 21.2 (12.3, 34.0) 3.5 (1.1, 10.4) 24.7 (14.5, 38.9)
Severely insecure 17 28.4 (12.1, 53.4) 2.7 (0.3, 18.7) 31.2 (14.2, 55.3)
TOTAL 394 5.0 (3.1, 7.8) 20.4 (16.1, 25.4) 25.4 (20.3, 31.2)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Deficient <12 ng/mL (<30nmol/L); Insufficient 12-19.9 ng/mL (<50nmol/L). Vitamin D concentrations below the limit of detection (<9
ng/mL; n=11) were recoded to 9 ng/mL.
b
25% sub-sample
c
Percentages weighted for unequal probability of selection.
d
CI=confidence interval, calculated taking into account the complex sampling design.
e
Chi-square p-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

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3.3.14. Associations between micronutrient deficiencies and various factors

Anemia in children 6-59 months is strongly associated with ID (see Table 33), and the prevalence of anemia
in iron deficient children is three times higher compared to iron sufficient children. Children who consume
fortified cereal were shown to have a significantly higher anemia prevalence than those not consuming fortified
cereal. However, ancillary analysis (data not shown) revealed that, in this case, the consumption of fortified baby
cereal is essential a proxy for age and is significantly associated with anemia because the anemia prevalence
is significantly higher in children <23 months of age; an age group that consumes more fortified baby cereals
than older age groups. No significant associations between anemia and any of the other investigated indicators
was detected.

Table 33. Correlation between various factors and anemia in children 6-59 months of age, the Kyrgyz
Republic 2021

Characteristic N %a Anemic p-valueb

Child had diarrhea
Yes 100 15.7 0.288
No 1097 21.3
Child had fever
Yes 145 21.5 0.854
No 1060 20.8
Child had lower respiratory infection
Yes 10 14.2 0.480
No 1197 21.0
Child’s household had safe drinking water
Yes 1176 21.1 0.529
No 30 17.2
Consumed commercially fortified baby cereal
Yes 106 30.7 <0.05
No 1065 20.0
Consumed micronutrient powder
Yes 22 11.5 0.208
No 1155 21.2
Consumed infant formula with added iron
Yes 60 29.9 0.129
No 1111 20.3
Took iron tablet or syrup in past 6 months
Yes 112 24.1 0.469
No 1085 20.7
Took multivitamin supplement in past 6 months
Yes 207 22.0 0.753
No 987 20.7
Household flour iron fortification c

None 230 16.0 0.752

Insufficient 78 19.6
Adequate 8 19.0
Child had inflammation
Yes 318 20.8 0.729
No 823 19.6

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Child iron deficient

Yes 540 31.5 <0.001
No 601 9.5
Child vitamin A deficient
Yes 159 18.7 0.691
No 982 20.2
Child vitamin D status d

Normal 264 20.4 0.277

Insufficient 96 27.8
Deficient 29 14.2
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous
fumarate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm
d
Vitamin D deficiency measured in a 25% sub-sample of children

Table 34 presents the correlations between ID and potential risk factors. This analysis shows that children who
had consumed infant formula with added iron the day before the survey have a lower prevalence of ID than those
who did not consume the infant formula. Also, there is indication that children who consumed iron syrup in the
6 months prior to the survey are less likely to be iron deficient than children who did not, albeit this difference
is not statistically significant. Moreover, the data also suggests that children with vitamin A deficiency are more
likely to be iron deficient, though the difference is not statistically significant. Other variables investigated here
are not significantly associated with ID.

Table 34. Correlation between various factors and iron deficiency in children 6-59 months of age, the Kyrgyz
Republic 2021

%a Iron
Characteristic N p-valueb
deficiency
Child had diarrhea
Yes 92 48.3 0.866
No 1051 47.1
Child had fever
Yes 142 39.2 0.069
No 1009 48.6
Child had lower respiratory infection
Yes 10 27.0 0.269
No 1143 47.6
Child’s household had adequate sanitation
Yes 978 47.6 0.350
No 178 43.1
Child’s household had safe drinking water
Yes 1126 46.9 0.934
No 30 47.9
Minimum dietary diversity
Yes 97 44.9 0.127
No 234 57.1

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 REPORT- OCTOBER 2022

Consumed commercially fortified baby cereal

Yes 95 39.2 0.231
No 1023 47.9
Consumed micronutrient powder
Yes 23 37.5 0.661
No 1101 47.5
Consumed infant formula with added iron
Yes 53 28.6 <0.05
No 1066 47.9
Took iron tablet or syrup in past 6 months
Yes 106 38.0 0.076
No 1037 48.0
Took multivitamin supplement in past 6 months
Yes 199 46.7 0.868
No 943 47.5
Household flour iron fortification c

None 220 39.1 0.393

Insufficient 76 42.8
Adequately fortified 8 59.4
Child had inflammation
Yes 326 43.2 0.187
No 835 48.7
Child vitamin A deficient
Yes 163 54.5 0.078
No 998 45.7
Child vitamin D statusd
Normal 267 50.8 0.949
Insufficient 98 49.1
Deficient 29 48.2
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous
fumarate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm
d
Vitamin D deficiency measured in a 25% sub-sample of children

There is some evidence that children with vitamin A deficiency have a higher prevalence of investigated
morbidities two weeks prior to the survey, though this difference is only significant for lower respiratory
infections and fever (see Table 35). Moreover, children who consumed micronutrient powders or commercially
fortified baby cereal the day before the survey have substantially lower prevalences of vitamin A deficiency,
though this difference is not significant due to the small number of children. None of the other investigated
indicators are significantly associated with vitamin A deficiency.

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Table 35. Correlation between various factors and vitamin A deficiency in children 6-59 months of age, the
Kyrgyz Republic 2021

%a Vit A
Characteristic N p-valueb
deficiency
Child had diarrhea
Yes 92 20.8 0.346
No 1051 14.2
Child had fever
Yes 142 20.2 <0.05
No 1009 13.5
Child had lower respiratory infection
Yes 10 48.8 <0.05
No 1143 14.2
Child’s household had adequate sanitation
Yes 978 14.4 0.466
No 178 17.7
Child’s household had safe drinking water
Yes 1126 14.7 0.344
No 30 22.3
Minimum dietary diversity
Yes 97 10.0 0.4150
No 234 13.6
Consumed commercially fortified baby cereal
Yes 95 7.4 0.102
No 1023 15.5
Consumed micronutrient powder
Yes 23 2.2 0.099
No 1101 15.2
Took multivitamin supplement in past 6 months
Yes 199 10.6 0.365
No 943 15.5
Child had fever
Yes 326 13.2 0.356
No 835 15.8
Child vitamin D status c

Normal 267 11.0 0.6177

Insufficient 98 15.4
Deficient 29 9.7
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Vitamin D deficiency measured in a 25% sub-sample of children

None of the investigated risk factors of vitamin D are significantly associated with vitamin D deficiency. This
might, at least partially owed to the small number of children included in the analyses (see Table 36).

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Table 36. Correlation between various factors and vitamin D deficiency in children 6-59 months of age, the
Kyrgyz Republic 2021

%a, c Vitamin D deficient

Characteristic N p-valueb
or insufficient
Child had diarrhea
Yes 32 33.4 0.296
No 352 23.4
Child had fever
Yes 41 19.3 0.511
No 349 24.9
Child had lower respiratory infection
Yes 3 0 0.447
No 387 24.6
Child’s household had adequate sanitation
Yes 328 25.3 0.823
No 63 23.4
Child’s household had safe drinking water
Yes 382 24.7 0.601
No 9 33.8
Consumed commercially fortified baby cereal
Yes 40 39.0 0.058
No 338 22.4
Took multivitamin supplement in past 6 months
Yes 64 24.5 0.961
No 320 24.2
Took vitamin D tablets or syrup in past 6 months
Yes 66 16.8 0.139
No 321 25.5
Is taking vitamin D tablets or syrup at the time of the survey
Yes 26 21.1 0.539
No 38 14.5
Took fish oil supplements in past 6 months Took fish oil supplements in past 6 months
Yes 25 18.8 0.556
No 360 24.4
Is taking fish oil supplements at the time of the survey
Yes 12 20.7 0.668
No 8 13.4
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Vitamin D deficiency measured in a 25% sub-sample of children

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.4. Children 5-9 years of age

3.4.1. Characteristics

Table 37 describes the demographic characteristics of children aged 5-9 years participating in the NIMAS. The
characteristics of the children 5-9 years of age included in the survey are similar to those of the actual Kyrgyz
population assessed in the Census 2009, except that children from Bishkek are slightly underrepresented in
the survey population.

Table 37. Description of children 5-9 years of age, the Kyrgyz Republic 2021
Children in Kyrgyz
Characteristic N %a (95% CI)b
population (%) [63]
Age Group (in years)
5 353 20.3 (18.4, 22.3) 21
6 352 20.3 (18.4, 22.3) 21
7 347 20.2 (18.1, 22.5) 20
8 340 19.6 (17.6, 21.7) 20
9 338 19.7 (17.8, 21.7) 19
Sex
Male 868 49.2 (46.6, 51.7) 51
Female 860 50.8 (48.3, 53.4) 49
Residence
Urban 632 30.4 (27.7, 33.3) 33
Rural 1098 69.6 (66.7, 72.3) 67
Region
Batken oblast 238 10.0 (8.6, 11.5) 9
Jalal-Abad oblast 202 18.0 (15.5, 20.8) 20
Issyk-Kul oblast 168 7.6 (6.4, 9.1) 7
Naryn oblast 176 4.7 (3.9, 5.6) 4
Osh oblast 263 23.9 (21.2, 26.8) 23
Talas oblast 201 5.5 (4.7, 6.4) 4
Chui oblast 155 15.3 (13.2, 17.6) 14
Bishkek city 121 9.6 (7.9, 11.8) 15
Osh city 206 5.5 (4.7, 6.5) 4
Wealth quintile
Lowest 466 25.8 (22.5, 29.4)
Second 378 22.3 (19.6, 25.3)
Middle 382 23.5 (20.6, 26.7)
Fourth 321 18.9 (15.9, 22.3)
Highest 177 9.5 (7.5, 11.9)
TOTAL 1730
Note: The N’s are un-weighted numbers in each subgroup. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.4.2. Schooling and school feeding

As shown in Table 38, four out of five children ever attended school. Of those children attending school at the
time of the survey, about 85% received school meals. Almost two-thirds of children had home schooling due
to COVID, on average 175 days. For the majority of children, home-schooling had no negative effect on health.

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Table 38. Schooling and school feeding of children 5-9 years of age, the Kyrgyz Republic 2021

Characteristic N %a, Mean (95% CI)b

Child ever attended school
Yes 1401 81.3 (79.1, 83.4)
No 329 18.7 (16.6, 20.9)
Child attended school at the time of the survey c

Yes 1387 99.0 (98.3, 99.4)

No 14 1.0 (0.6, 1.7)
School meal provision
Child received hot meal 769 54.8 (49.0, 60.5)
Child received bun and tea 403 30.0 (24.8, 35.8)
No food provided at school 196 14.0 (11.7, 16.7)
Don`t know 19 1.2 (0.7, 2.0)
Child had home schooling due to COVID-19
Yes 844 61.9 (59.1, 64.7)
No 530 37.3 (34.5, 40.2)
Mean number of home-schooling days (mean) 833 175 (167, 184)
Home-schooling affected health of child
Yes 112 11.2 (9.0, 14.0)
No 696 84.8 (81.8, 87.4)
Don’t know 36 3.9 (2.7, 5.6)
How was child health affectedd
Lack of nutritious food due to absence of school
5 5.4 (2.0, 14.1)
meals
Child often sick or depressed 85 76.0 (66.9, 83.3)
Lack of nutritious food & child often sick or de-
7 5.6 (2.5, 12.3)
pressed
Don’t know 13 12.9 (7.1, 22.3)
Note: The N’s are the numerators for a specific sub-group. The percentages do not add up to 100% because the small proportion of
the respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
a
Percentages and means weighted for unequal probability of selection among regions.
b
CI=confidence interval calculated taking into account the complex sampling design.
c
Only including those who ever attended school.
d
Only including those whose health was affected by home- schooling.

3.4.3. Recent illness and health indicators

More than 90% of children were weighed at birth, and of these children, less than 5% had low birth weight.
The proportion of children having a lower respiratory infection and diarrhea in the two weeks preceding the
survey was below 5%, and the prevalence of those suffering from fever was below 10% (see Table 39). The low
morbidity burden is corroborated by the low proportion of children with elevated inflammation markers.

Table 39. Health indicators in children 5-9 years of age, the Kyrgyz Republic 2021
Characteristic N %a, Mean (95% CI)b
Child weighed at birth
Yes 1600 92.4 (90.5, 93.8)
No 6 0.3 (0.1, 0.8)
Don’t know 124 7.3 (5.9, 9.1)
Birthweight in kilograms (mean) 1508 3310 (3281, 3340)

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Low birth weight

<2500 грамм 74 4.3 (3.3, 5.7)
2500+ грамм 1434 95.7 (94.3, 96.7)
Had lower acute respiratory infection in past 2c
Yes 11 1.0 (0.5, 2.3)
No 1719 99 (97.7, 99.5)
Had diarrhea in past 2 weeks
Yes 47 2.3 (1.5, 3.3)
No 1682 97.7 (96.6, 98.4)
Had fever in past 2 weeks
Yes 141 9.5 (7.6, 11.7)
No 1587 90.4 (88.2, 92.3)
Inflammationd
None 1098 79.6 (76.8, 82.1)
Early (High CRP, Normal AGP) 25 1.5 (1, 2.3)
Acute (High CRP, High AGP) 102 6.9 (5.4, 8.8)
Convalescent (Normal CRP, High AGP) 163 12.0 (10.1, 14.2)
Note: The N’s are the numerators for a specific sub-group. The percentages do not add up to 100% because the small proportion of
the respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
a
Percentages and means weighted for unequal probability of selection among regions.
b
CI=confidence interval calculated taking into account the complex sampling design.
c
Questions on recent illness were phrased according to the MICS manual [68].
d
The various stages of inflammatory response was defined by Thurnham et al [39].

3.4.4. Dietary diversity

On average, children consumed 6.4 food groups (out of a potential 10 food groups) the day before the survey
and more than two-thirds of the children had minimum dietary diversity (i.e., the consumption of ≥5 food
groups). Significant differences were detected between the regions: In Batken, Jalal Abad and Osh Oblast,
approximately 80% of children consumed ≥5 food groups, whereas in Chui and Bishkek less than half of the
children consumed ≥5 food groups. Moreover, urban/rural residence and household wealth are significantly
associated with dietary diversity. A larger proportion of children in rural areas consumed ≥5 food groups
compared to children in urban centers. When examined by wealth quintile, children residing in the wealthiest
households had the lowest proportion of minimum dietary diversity (~60%). Minimum dietary diversity was also
significantly associated with household food security status, and a dose-response relationship was observed
whereby the proportion of children with minimum dietary diversity steadily increased as the household food
security status improved. No significant differences were detected between the different age groups and
between boys and girls.

Table 40. Dietary diversity in children 5-9 years of age, the Kyrgyz Republic 2021
Consumed 5+ food groups Mean dietary
Characteristic
N % a
(95% CI) b
p-value c score
Age Group (in years)
5 353 67.9 (62.1, 73.2) 0.677 6.2
6 352 72.3 (66.1, 77.7) 6.4
7 347 72.1 (66.2, 77.2) 6.5
8 340 70.4 (64.9, 75.4) 6.4
9 338 68.4 (62.7, 73.5) 6.4
Sex
Male 868 69.6 (66.1, 72.8) 0.635 6.4
Female 860 70.7 (66.7, 74.4) 6.4

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 REPORT- OCTOBER 2022

Residence
Urban 632 61.3 (56.6, 65.8) <0.001 6.0
Rural 1098 74.1 (70.5, 77.4) 6.5
Region
Batken oblast 238 81.5 (75.8, 86.1) <0.001 7.3
Jalal-Abad oblast 202 82.7 (76.6, 87.4) 6.9
Issyk-Kul oblast 168 76.8 (66.9, 84.4) 6.6
Naryn oblast 176 67.9 (58.4, 76.1) 6.3
Osh oblast 263 84.4 (78.0, 89.3) 6.8
Talas oblast 201 58.7 (48.9, 67.8) 5.9
Chui oblast 155 45.9 (37.1, 55.0) 5.3
Bishkek city 121 45.3 (35.1, 56.0) 5.2
Osh city 206 62.9 (57.5, 68.1) 6.0
Wealth quintile
Highest 466 66.9 (60.5, 72.7) <0.01 6.1
Second 378 76.6 (70.4, 81.8) 6.6
Middle 382 75.2 (68.6, 80.8) 6.7
Fourth 321 66.3 (59.0, 73.0) 6.3
Highest 177 59.3 (49.6, 68.2) 5.8
Household food security
Secure 1097 74.0 (70.4, 77.4) <0.001 6.4
Mildly insecure 206 73.0 (64.1, 80.3) 6.0
Moderately insecure 314 60.3 (53.6, 66.6) 5.6
Severely insecure 107 50.3 (36.3, 64.2) 4.7
TOTAL 1730 70.2 (67.3, 73.0) 6.4
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
P-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

3.4.5. Consumption of vitamins and supplements

As shown in Table 41 below, supplement and vitamin consumption is uncommon in children 5-9 years of age.
In the past 6 months, less than 5% of children consumed vitamin A supplements and less than 10% consumed
iron tablets/ syrup or vitamin D tablets/ syrup or fish oil supplements. Multivitamins were the most common
supplement and were consumed by 13% of children in the six months prior to the survey.

Table 41. Consumption of iron, vitamin A and vitamin D supplements in children 5-9 years of age, the Kyrgyz
Republic 2021

Characteristic N %a (95% CI)b

Took iron tablet or syrup in past 6 months
Yes 127 7.0 (5.5, 8.7)
No 1595 92.5 (90.5, 94.0)
Don’t know 8 0.6 (0.2, 1.7)
Is still taking iron
Yes 45 34.2 (24.1, 45.9)
No 80 65.8 (54.1, 75.9)
Took vitamin A tablets or other preparations in past 6 months
Yes 84 4.5 (3.5, 5.7)
No 1634 94.8 (93.4, 95.9)
Don’t know 12 0.7 (0.3, 1.5)

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Is still taking vitamin A

Yes 32 38.1 (26.0, 51.8)
No 45 61.9 (48.2, 74.0)
Took multivitamin tablets or other preparations in past 6 months
Yes 237 13.0 (10.9, 15.4)
No 1483 86.6 (84.2, 88.7)
Don’t know 10 0.4 (0.2, 0.8)
Is still taking multivitamins
Yes 80 28.9 (22.2, 36.6)
No 156 71.1 (63.4, 77.8)
Took vitamin D tablets or syrup in past 6 months
Yes 131 7.1 (5.7, 8.7)
No 1591 92.5 (90.8, 93.9)
Don’t know 8 0.4 (0.2, 1.0)
Is still taking vitamin D tablets or syrup
Yes 45 27.8 (19.8, 37.5)
No 84 72.2 (62.5, 80.2)
Took fish oil supplements in past 6 months
Yes 111 6.3 (5.0, 7.9)
No 1608 93.2 (91.5, 94.5)
Don’t know 11 0.5 (0.3, 1.1)
Is still taking fish oil supplements
Yes 41 31.2 (22.1, 42.1)
No 80 68.8 (57.9, 77.9)
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.4.6. Short stature

As shown in Table 42 below, about one out of ten children aged 5-9 years have short stature (i.e., height-for-
age z score <-2 SD). Although no significant differences were detected for any of the investigated indicators,
the data suggests that short stature is more prevalent in older kids, in females, and in children living in poor
households.

20
Percent of children

15

10

0
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
Height-for-age Z score (HAZ)

WHO Growth reference Survey sample: SD=1.07

Figure 14. Distribution of height-for-age z-scores in children 5-9 years of age, the Kyrgyz Republic 2021

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 REPORT- OCTOBER 2022

Figure 14 shows the distribution of the height-for-age z-score in the surveyed population of children 5-9
years of age. It shows that the distribution is very slightly shifted towards the left of the standard growth
curve, indicating that height-for-age z-scores were, on average, slightly lower than those in the WHO Growth
Standard population.

Table 42. Percentage of children 5-9 years of age with short stature, the Kyrgyz Republic 2021

Characteristic N %a, b (95% CI)c p-valued

Age Group (in years)
5 260 2.9 (1.5, 5.4) 0.091
6 298 2.3 (1.0, 5.0)
7 293 3.5 (1.7, 7.1)
8 290 7.0 (3.7, 12.7)
9 289 5.7 (3.1, 10.4)
Low birth weight
Yes 62 5.7 (1.8, 17.0) 0.557
No 1200 4.0 (2.9, 5.5)
Sex
Male 719 3.3 (2.2, 5.0) 0.118
Female 711 5.3 (3.4, 8.1)
Residence
Urban 485 3.9 (2.1, 7.0) 0.699
Rural 945 4.5 (3.0, 6.5)
Region
Batken oblast 219 5.0 (2.7, 9.1) 0.464
Jalal-Abad oblast 170 3.9 (1.5, 9.5)
Issyk-Kul oblast 145 3.2 (1.2, 8.5)
Naryn oblast 165 2.4 (1.0, 5.7)
Osh oblast 217 5.3 (2.9, 9.4)
Talas oblast 162 6.3 (2.8, 13.7)
Chui oblast 106 5.7 (2.2, 13.9)
Bishkek city 83 0 (0, 0)
Osh city 163 4.0 (1.7, 8.8)
Wealth quintile
Highest 409 6.4 (3.7, 10.9) 0.075
Second 319 5.3 (3.1, 9.1)
Middle 322 4.1 (2.2, 7.7)
Fourth 246 2.4 (1.1, 5.2)
Highest 128 0 (0, 0)
Household food security
Secure 887 3.9 (2.7, 5.5) 0.263
Mildly insecure 182 3.0 (0.9, 9.3)
Moderately insecure 273 4.9 (2.5, 9.2)
Severely insecure 82 10.5 (2.9, 31.7)
Household sanitation e

Unadequate 220 3.6 (1.7, 7.4) 0.074

Adequate 1200 4.4 (3.1, 6.2)

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Safe drinking waterf

Yes 1387 4.4 (3.2, 6.1) 0.676
No 35 0 (0, 0)
TOTAL 1430 4.3 (3.1, 5.9)
Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Short stature is defined as having a height-for-age z-score below -2 standard deviations from the WHO Growth reference data for 5-19
years population median.
b
Percentages weighted for unequal probability of selection.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking

3.4.7. Thinness, overweight and obesity

As shown in Table 43, thinness is uncommon and affects less than 2% of Kyrgyz children 5-9 years of age.
Thinness is only significantly associated with household food security, but there is no clear trend in the results,
with children residing in “mildly food insecure” households having a significantly higher thinness prevalence
than the other groups.

To our knowledge there is no classification of the overweight or obesity prevalence for children 5-9 years
of age. Using the classification for children below 5 years of age, the prevalence of overweight (BMI>25) is
considered “high” by WHO guidelines [70]. Overweight and obesity are significantly associated with birth
weight status, residence, and household wealth quintile. Specifically, the prevalence of overweight and obesity
is significantly higher among children that were not born with low birthweight. Overweight and obesity are
also significantly higher in urban areas compared to rural areas, and higher amongst children residing in the
wealthiest households.

Bishkek city
Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city
Overweight & obesity (%)
Osh oblast 0,0 - 4,9
5,0 - 9,9
Batken oblast 10,0 - 14,9
15,0 - 19,9
20,0 - 25,0

Figure 15. Prevalence of overweight and obesity in children 5-9 years of age, the Kyrgyz Republic 2021

88
 Table 43. Prevalence of thinness, overweight and obesity in children 5-9 years of age, the Kyrgyz Republic 2021

Thinnessd Overweightd Obesed Overweight или obese

Characteristic N b c a b b
% (95% CI) p-value % (95% CI) % (95% CI) % (95% CI)b p-valuec
Age (in years)
5 259 0.7 (0.1, 3.5) 0.854 13.2 (9.5, 18.1) 2.4 (1.1, 5.4) 15.6 (11.4, 21.1) 0.402
6 297 1.7 (0.7, 4.1) 8.0 (5.0, 12.8) 3.0 (1.3, 6.7) 11.0 (7.4, 16.0)
7 293 1.6 (0.7, 3.7) 9.5 (6.5, 13.7) 2.5 (1.0, 6.0) 12.1 (8.6, 16.6)
8 290 1.2 (0.3, 3.8) 10.5 (7.0, 15.6) 3.1 (1.4, 6.5) 13.6 (9.6, 18.9)
9 289 1.5 (0.6, 3.7) 10.8 (7.1, 16.2) 6.0 (2.7, 12.8) 16.8 (11.6, 23.7)
Low birth weight
Yes 61 2.4 (0.8, 7.3) 0.305 2.6 (0.6, 10.2) 0.0 - 2.6 (0.6, 10.2) <0.01
No 1200 1.2 (0.7, 2.2) 10.5 (8.9, 12.5) 3.6 (2.3, 5.5) 14.1 (11.9, 16.6)
Sex
Male 718 1.7 (0.9, 3.3) 0.265 11.7 (9.5, 14.4) 3.5 (2, 6.2) 15.2 (12.4, 18.6) 0.213
Female 710 1.0 (0.5, 2.0) 9.0 (6.7, 11.8) 3.3 (2, 5.4) 12.3 (9.4, 15.8)
Residence
Urban 485 2.3 (1.1, 4.8) 0.057 12.1 (9.1, 15.8) 4.9 (2.6, 9.3) 17.0 (13.2, 21.6) <0.05
Rural 943 0.9 (0.5, 1.8) 9.6 (7.9, 11.6) 2.8 (1.7, 4.6) 12.4 (10.2, 15)
Region
Batken oblast 219 1.3 (0.4, 4.0) 0.364 7.5 (4.8, 11.4) 4.4 (2.4, 8) 11.9 (8.7, 16.0) 0.105
Jalal-Abad oblast 170 2.2 (0.7, 6.4) 9.3 (6.8, 12.5) 0 (, ) 9.3 (6.8, 12.5)
Issyk-Kul oblast 144 1.3 (0.4, 4.4) 15.2 (10.7, 21.2) 3 (1.1, 7.8) 18.3 (13.6, 24.1)
Naryn oblast 164 4.1 (2.1, 7.9) 6.6 (3.5, 12.1) 1.8 (0.6, 5.2) 8.4 (4.4, 15.4)
Osh oblast 217 0.5 (0.1, 3.6) 8.6 (6.2, 11.7) 4.9 (2.4, 9.7) 13.4 (10.2, 17.6)
Talas oblast 162 0.9 (0.3, 3.0) 10.6 (6.3, 17.3) 1 (0.2, 4.1) 11.6 (7.3, 18.0)
Chui oblast 106 0.7 (0.1, 4.7) 12.4 (7.3, 20.2) 4.1 (1.5, 10.3) 16.4 (9.5, 26.9)
Bishkek city 83 1.8 (0.5, 6.7) 13.9 (7.7, 23.8) 7.2 (1.9, 23.4) 21.1 (12.0, 34.4)
Osh city 163 1.9 (0.4, 8.8) 11.5 (7.4, 17.4) 3.2 (1.3, 7.5) 14.7 (9.3, 22.5)
Wealth quintile
Highest 408 1.7 (0.8, 3.5) 0.627 8.6 (6.2, 11.8) 2.3 (1.2, 4.2) 10.8 (8.0, 14.5) <0.01
Second 318 1.6 (0.6, 4.1) 7.0 (4.5, 10.8) 2.3 (1.1, 5.0) 9.4 (6.5, 13.3)

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REPORT- OCTOBER 2022
90
Middle 322 1.1 (0.4, 2.9) 10.6 (7.6, 14.6) 3.4 (1.5, 7.6) 14.1 (10.0, 19.5)
Fourth 246 0.6 (0.1, 2.6) 13.9 (9.7, 19.6) 4.2 (2.3, 7.8) 18.2 (13.3, 24.3)
Highest 128 2.2 (0.6, 7.3) 15.8 (9.5, 25.3) 8.0 (2.4, 23.5) 23.8 (14.7, 36.3)
Household food security
Secure 887 1.0 (0.5, 1.8) <0.001 10.3 (8.5, 12.5) 3.8 (2.4, 5.9) 14.1 (11.8, 16.8) 0.915
Mildly insecure 182 5.7 (2.6, 12.0) 11.5 (6.9, 18.5) 2.4 (0.9, 6.0) 13.9 (8.2, 22.5)
Moderately insecure 271 0.4 (0.1, 1.8) 10.3 (7.1, 14.9) 3.2 (1.1, 8.8) 13.6 (9.4, 19.1)
Severely insecure 82 0.0 - 8.4 (3.3, 19.7) 2.3 (0.7, 6.9) 10.7 (5.0, 21.4)
Household sanitation e
Unadequate 220 0.0 - 0.269 8.1 (5.2, 12.5) 2.1 (0.9, 4.9) 10.2 (6.6, 15.5) 0.250
Adequate 1198 1.6 (1.0, 2.6) 10.8 (9.1, 12.7) 3.7 (2.4, 5.6) 14.5 (12.4, 16.9)
Safe drinking waterf
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Yes 1385 1.4 (0.9, 2.3) 0.849 10.2 (8.7, 12.0) 3.5 (2.4, 5.3) 13.7 (11.7, 16.1) 0.807
No 35 0.0 - 16.6 (7.0, 34.7) 0.0 - 16.6 (7.0, 34.7)
TOTAL 1428 1.4 (0.8, 2.2) 10.3 (8.8, 12.1) 3.4 (2.3, 5.1) 13.8 (11.8, 16.0)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
CI=confidence interval, calculated taking into account the complex sampling design.
c
P-value <0.05 indicates that at least one subgroup is significantly different from the others.
d
Thinness is defined as BMI-for-age z-score smaller than -2, overweight is defined as having a BMI-for-age z-score greater than +2 but less than or equal to +3 standard deviations and obesity is
defined as having a BMI-for-age z-score greater than +3 standard deviations from the WHO Growth reference data for age 5-19 population median.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
hold. Inadequate sanitation = open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
 REPORT- OCTOBER 2022

3.4.8. Underweight

Similar to short stature and thinness, underweight is not very common in children 5-9 years of age (see Table
44). Although none of the investigated indicators is significantly associated with underweight, data suggests
that children born with low birth weight are more likely to be underweight than those who were born with
normal weight. Moreover, it seems that females and children living in households of the lower wealth quintiles
are more likely to be underweight than boys and children residing in wealthier households.

20
Percent of children

15

10

0
-5 -4 -3 -2 -1 0 1 2 3 4 5
Weight-for-age Z score (WAZ)
WHO Growth reference Survey sample; SD=0.98

Figure 16. Distribution of weight-for-age z-scores in children 5-9 years of age, the Kyrgyz Republic 2021

Figure 16 shows the distribution of the weight-for-age z-score in the surveyed population of children 5-9
years of age. It shows that the distribution is very slightly shifted towards the left of the standard growth
curve, indicating that weight-for-age z-scores were on average slightly smaller than those in the WHO Growth
Standard population.

Table 45. Percentage of children 5-9 years of age with underweight, the Kyrgyz Republic 2021

Characteristic N %a, b (95% CI)c p-valued

Age Group (in years)
5 260 1 (0.4, 2.9) 0.111
6 298 1.4 (0.5, 4)
7 293 2.5 (1.2, 5.2)
8 290 4.9 (2.1, 11)
9 284 3 (1.2, 6.9)
Low birth weight
Yes 62 5.7 (1.8, 17) 0.057
No 1196 2.1 (1.3, 3.4)
Sex
Male 718 1.8 (0.9, 3.5) 0.118
Female 707 3.4 (1.9, 5.8)
Residence
Urban 483 3.4 (1.6, 6.8) 0.412
Rural 942 2.3 (1.2, 4.1)
Region
Batken oblast 218 2.1 (1, 4.5) 0.218

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Jalal-Abad oblast 170 3.4 (1.2, 9.4)

Issyk-Kul oblast 145 0.6 (0.1, 3.9)
Naryn oblast 165 1.9 (0.7, 5.3)
Osh oblast 216 1.2 (0.4, 3.8)
Talas oblast 160 1.5 (0.5, 4.4)
Chui oblast 106 5.5 (2, 14.3)
Bishkek city 82 2.5 (0.6, 9.6)
Osh city 163 3.5 (1.4, 8.8)
Wealth quintile
Lowest 408 3.9 (1.6, 9.1) 0.132
Second 318 4.1 (2.1, 7.8)
Middle 320 1.6 (0.7, 3.7)
Fourth 245 1 (0.3, 3.5)
Highest 128 1.3 (0.3, 5.6)
Household food security
Secure 883 2.4 (1.5, 3.8) 0.438
Mildly insecure 182 3.6 (1.2, 10.3)
Moderately insecure 272 1.6 (0.4, 5.6)
Severely insecure 82 6.7 (0.9, 34.8)
Household sanitation e

Unadequate 219 2.7 (1.2, 6.3) 0.967

Adequate 1196 2.6 (1.6, 4.2)
Safe drinking waterf
Yes 1382 2.7 (1.7, 4.2) 0.779
No 35 0 (0, 0)
TOTAL 1425 2.6 (1.6, 4.1)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Underweight is defined as having a weight-for-age z-score below -2 standard deviations from the WHO Growth reference data for age
5-19 population median.
b
Percentages weighted for unequal probability of selection.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking.

3.4.9. Anemia, iron deficiency, and iron deficiency anemia

The prevalence of anemia in children 5-9 years of age is low (Table 45). While none of the children is severely anemic
about half can be classified as moderately or mildly anemic (see appendix 8.3, Table 90). According to WHO, anemia
in children 5-9 years of age can be considered a mild public health problem [36].

The highest anemia prevalence occurs in children 5 years of age, almost consistently decreasing with increasing
age. Moreover, anemia is significantly associated with household food insecurity, with the largest proportion of
anemic children living in mildly food insecure households. No associations were found between anemia and low birth
weight, child’s sex, urban/rural residence, region, household wealth quintile, household sanitation and household
access to safe drinking water.

The distribution of hemoglobin values for children is shown in Figure 17. It is roughly symmetric with the majority
of values above the cut-off point of 115 g/L. Median hemoglobin concentration among all children 5-9 years of age
is 127 g/L.

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 REPORT- OCTOBER 2022

25

20
Percent of children

15

10

0
70 80 90 100 110 120 130 140 150 160 170 180 190
Hemoglobin concentration (g/L)
Median: 127 g/L Survey sample
Figure 17. Distribution of adjusted hemoglobin (g/L) in children 5-9 years, the Kyrgyz Republic 2021

With about 30%, ID is much more common than anemia in children 5-9 years of age (Table 45). Similar to
anemia, ID is significantly associated with the child’s age and highest in young children. Other variables, such
as sex, low birth weight, urban/rural residence, region, household wealth, household food security, household
sanitation and access to safe drinking water are not associated with ID with statistical significance.

Almost 60% of the children who have anemia also have ID. Similar to anemia and ID, the highest prevalence
of IDA was found in children 5 years of age. Also, IDA is significantly associated with household food insecurity
and household sanitation. Highest prevalences were detected in children living in mildly food insecure
households and in households with adequate sanitation. Other demographic variables investigated here are
not significantly associated with IDA.

Figure 18 illustrates the overlap between anemia and ID in children 5-9 years of age, showing a large overlap
between anemia and ID.

5% 25%
anemia iron
3% deficiency iron
only deficiency
anemia
only

Figure 18. Venn diagram showing overlap between anemia and iron deficiency in children 5-9 years of age,
the Kyrgyz Republic 2021

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 Table 46. Prevalence of anemia, iron deficiency, and iron deficiency anemia in children 5-9 years of age, by various demographic characteristics, the Kyrgyz

94
Republic 2021.

Anemiab Iron deficiencye Iron deficiency anemia f

Characteristic a c d a c d
N % 95% CI p-value N % 95% CI p-value N %a 95% CIc p-valued
Age Group (in years)
5 274 15.7 (11.5, 21.2) <0.0001 266 33.1 (29.3, 45.0) <0.05 263 10.3 (6.6, 15.6) <0.001
6 289 7.7 (4.6, 12.6) 284 26.3 (26.3, 40.6) 278 4.3 (2.4, 7.9)
7 275 6.1 (3.7, 9.8) 271 26.3 (20.4, 33.2) 268 3.5 (1.8, 6.8)
8 282 3.4 (1.5, 7.4) 284 24.2 (20.7, 32.7) 278 1.2 (0.3, 4.2)
9 279 6.1 (3.5, 10.5) 280 29.2 (19.0, 30.3) 276 3.3 (1.4, 7.8)
Low birth weight
Yes 610 7.9 (3.2, 18.0) 0.924 59 28.6 (16.1, 45.6) 0.981 59 3.7 (1.2, 11.3) 0.775
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

No 1181 7.5 (5.7, 9.9) 1166 28.5 (24.9, 32.2) 1150 4.4 (3, 6.5)
Sex
Male 697 7.7 (5.6, 10.5) 0.896 691 30.1 (25.8, 34.8) 0.615 683 5.2 (3.3, 8) 0.266
Female 700 7.9 (5.7, 10.8) 692 28.6 (24.1, 33.5) 678 3.8 (2.3, 6.3)
Residence
Urban 473 8.7 (6.1, 12.3) 0.505 476 32.5 (26.3, 39.3) 0.228 464 4.8 (2.9, 7.9) 0.773
Rural 928 7.4 (5.2, 10.4) 912 27.8 (23.8, 32.2) 901 4.3 (2.6, 7.1)
Region
Batken oblast 220 4.3 (2.1, 8.6) 0.256 218 30.6 (23.7, 38.5) 0.391 218 3.4 (1.8, 6.6) 0.580
Jalal-Abad oblast 165 4.3 (2.1, 8.6) 163 26.4 (20.4, 33.4) 157 2.4 (0.8, 7.2)
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Issyk-Kul oblast 151 9.7 (5.4, 16.9) 152 35.3 (25.7, 46.2) 151 7.2 (3.6, 13.8)
Naryn oblast 164 11.1 (7, 17.2) 158 38.6 (30.7, 47.2) 158 7 (4.4, 10.9)
Osh oblast 203 8.3 (4.6, 14.5) 199 23.8 (16.9, 32.3) 195 3.9 (1.8, 8.5)
Talas oblast 160 14.8 (8.3, 25.2) 158 31.3 (24.0, 39.6) 158 8.3 (3.4, 18.9)
Chui oblast 103 9.5 (3.9, 21.1) 101 32.0 (20.2, 46.7) 100 5.1 (1, 22)
Bishkek city 83 7.1 (3.2, 15.0) 83 34.0 (22.2, 48.2) 81 4.8 (2.1, 11)
Osh city 152 6.0 (3.3, 10.7) 156 25.0 (18.6, 32.8) 147 2.4 (0.9, 6)
Wealth quintile
Lowest 402 7.6 (5.3, 11.0) 0.857 397 29.9 (24.3, 36.3) 0.924 394 3.6 (2, 6.3) 0.411
 Second 318 9.1 (5.9, 13.9) 311 27.4 (21.3, 34.5) 307 6.6 (3.8, 11.2)
Middle 310 7.6 (3.9, 14.2) 305 30.4 (23.7, 38.1) 300 4.6 (2, 10.4)
Fourth 239 7.6 (4.6, 12.4) 243 30.1 (22.4, 39.0) 237 3.8 (2, 7.1)
Highest 127 5.5 (2.5, 11.7) 127 26.1 (18.2, 35.8) 122 2.8 (1, 7.9)
Household food security
Secure 867 6.6 (4.7, 9.3) <0.01 860 28.2 (24.5, 32.3) 0.270 840 3.6 (2.4, 5.5) <0.01
Mildly insecure 173 17.5 (10.2, 28.3) 174 37.6 (27.7, 48.7) 171 11.3 (5.3, 22.6)
Moderately insecure 274 5.3 (3.2, 8.7) 269 27.4 (21.3, 34.4) 269 3.2 (1.7, 6)
Severely insecure 82 10.5 (5.1, 20.6) 80 28.5 (17.2, 43.4) 80 4.7 (1.5, 14)
g
Household sanitation
Unadequate 212 3.7 (1.8, 7.3) 0.073 215 27.2 (20.0, 35.9) 0.565 209 1.1 (0.4, 2.8) <0.05
Adequate 1180 8.5 (6.4, 11.2) 1164 29.4 (25.6, 33.5) 1147 5.1 (3.4, 7.5)
h
Safe drinking water
Yes 1357 8.0 (6.1, 10.3) 0.334 1345 29.0 (25.6, 32.6) 0.607 1322 4.6 (3.1, 6.7) 0.5435
No 37 2.0 (0.4, 9.1) 36 36.2 (17.6, 60.0) 36 1.2 (0.1, 9.1)
TOTAL 1401 7.8 (6.0, 10.0) 1388 29.2 (25.8, 32.8) 1365 4.5 (3.0, 6.5)
Note: The N’s are the denominators for a specific sub-group. For iron deficiency and iron deficiency anemia, the numbers are smaller than for anemia due to unsuccessful blood collection (sufficient
blood could be obtained only for the on-site analysis of hemoglobin concentration).
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Anemia defined as hemoglobin < 115 g/L adjusted for altitude.
c
CI=confidence interval calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups
e
Iron deficiency defined as inflammation adjusted plasma ferritin < 15 µg/L.
f
Iron deficiency anaemia defined as plasma ferritin < 15.0 μg/L and hemoglobin < 115 g/L.
g
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
hold. Inadequate sanitation = open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field
h
Composite variable of main source of drinking water and treating water to make safe for drinking

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3.4.10. Vit A deficiency

The prevalence of vitamin A deficiency in Kyrgyz children 5-9 years of age would be classified as moderate by
WHO [71], see Table 46. The prevalence tends to decrease with increasing age and tends to be higher in male
than in female children. Similar to vitamin A in children 6-59 months of age, the prevalence significantly differs
by region with the highest prevalence in Osh City and Chui, where the high prevalence poses a severe public
health problem. Lowest prevalence of vitamin A deficiency was observed in Naryn and Jalal Abad, where the
problem is of mild public health significance. Vitamin A deficiency does not significantly differ by child birth
weight, household wealth, urban/rural residence, and household food security status.

Table 47. Prevalence of vitamin A deficiency in children 5-9 years of age, by various demographic
characteristics, the Kyrgyz Republic 2021

Characteristic N % a with (95% CI)c p-valued

VADb
Age Group (in years)
5 266 20.2 (13.8, 28.5) 0.053
6 284 18.6 (13.8, 24.7)
7 271 18.8 (12.8, 26.7)
8 284 10.4 (7.1, 14.9)
9 280 12.5 (8.6, 17.9)
Low birth weight
Yes 59 11.1 (5.4, 21.5) 0.305
No 1166 15.9 (13.1, 19.2)
Sex
Male 691 18.5 (14.8, 22.9) 0.074
Female 692 13.8 (10.5, 17.8)
Residence
Urban 476 17.2 (13.5, 21.8) 0.629
Rural 912 15.5 (12.2, 19.5)
Region
Batken oblast 218 19.7 (13.9, 27.1) <0.01
Jalal-Abad oblast 163 8.2 (4.7, 13.7)
Issyk-Kul oblast 152 13.5 (8.9, 19.9)
Naryn oblast 158 7.5 (4.2, 12.8)
Osh oblast 199 18.7 (12.3, 27.4)
Talas oblast 158 10.9 (5.7, 20.0)
Chui oblast 101 22.5 (13.5, 35.1)
Bishkek city 83 12.3 (6.7, 21.5)
Osh city 156 27.5 (19.9, 36.8)
Wealth quintile
Lowest 397 13.7 (9.4, 19.4) 0.210
Second 311 18.4 (14.1, 23.7)
Middle 305 20.1 (14.2, 27.6)
Fourth 243 11.5 (6.6, 19.1)
Highest 127 16.3 (10.2, 25.2)
Household food security
Secure 860 14.3 (11.5, 17.7) 0.196
Mildly insecure 174 21.4 (14.6, 30.3)

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Moderately insecure 269 16.8 (11.3, 24.5)

Severely insecure 80 24.0 (11.9, 42.4)
TOTAL 1388 16.0 (13.4, 19.1)
Note: The N’s are the denominators for a specific sub-group; for VAD, the numbers are smaller than for anemia due to unsuccessful
blood collection (only sufficient blood could be obtained for the on-site analysis of hemoglobin concentration) or insufficient sample
volumes for retinol binding protein analysis.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
VAD = Vitamin A deficiency, defined as RBP adjusted for inflammation <0.569 umol/L.
c
CI=confidence interval calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups

3.4.11. Associations between micronutrient deficiencies and various factors

As can be seen in Table 47 anemia in children 5-9 years of age is strongly associated with iron deficiency,
the intake of iron tablets and syrup and inflammation. The prevalence of anemia in iron deficient children
is more than three times higher compared to iron sufficient children and the anemia prevalence in children
with elevated inflammation markers is twice as high as in those children without inflammation. Further, the
prevalence of anemia is three times higher in children who took iron syrup or tablets, possibly since iron syrup
and tablets have been administered to anemic children as treatment. Moreover, anemia is more prevalent in
children who ate 5 or more food groups the day before the survey compared to those children eating less than
5 food groups. Though not significant, the data indicates that a larger proportion of children with vitamin A
deficiency are anemic compared to children without vitamin A deficiency. No significant associations between
anemia and any of the other investigated indicators was detected.

Table 48. Correlation between various factors and anemia in children 5-9 years of age, the Kyrgyz Republic 2021
Characteristic N % a Anemia p-valueb
Child had diarrhea
Yes 37 14.3 0.123
No 1361 7.6
Child had fever
Yes 105 10.1 0.388
No 1292 7.5
Child had lower respiratory infection
Yes 8 0.0 0.538
No 1391 7.8
Minimum dietary diversity
Yes 980 8.8 <0.05
No 419 5.4
Took iron tablet or syrup in past 6 months
Yes 108 18.4 <0.001
No 1286 6.9
Took vitamin A tablets in past 6 months
Yes 68 16.0 <0.05
No 1322 7.2
Took multivitamin supplement in past 6 months
Yes 187 11.0 0.151
No 1203 7.3
Consumes coffee or tea during or directly after meal
Yes 1032 6.8 0.072
No 367 10.6

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Household flour iron fortificationc

None 303 8.6 0.884
НеAdequate 74 7.8
Adequately fortified 8 5.2
Child had inflammation
Yes 287 12.6 <0.005
No 1078 6.7
У ребенка Iron deficiency
Yes 423 15.0 <0.0001
No 942 4.9
Child vitamin A deficient
Yes 207 11.9 0.064
No 1158 7.1
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fuma-
rate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm

As shown in Table 48, ID is significantly associated with fever; a significantly smaller proportion of children with
fever two weeks prior to the survey are iron deficient. No other associations were detected between ID and any
of the investigated factors.

Table 49. Correlation between various factors and iron deficiency in children 5-9 years of age, the Kyrgyz
Republic 2021
Characteristic N %a Iron deficiency p-valueb
Child had diarrhea
Yes 35 30.8 0.845
No 1349 29.1
Child had fever
Yes 103 18.5 <0.05
No 1280 30.3
Child had lower respiratory infection
Yes 8 8.2 0.107
No 1377 29.4
Minimum dietary diversity
Yes 971 28.8 0.356
No 414 31.5
Took iron tablet or syrup in past 6 months
Yes 104 33.1 0.462
No 1276 29.0
Took multivitamin supplement in past 6 months
Yes 183 33.7 0.320
No 1193 28.5
Consumes coffee or tea during or directly after meal
Yes 1024 29.0 0.789
No 361 30.0
Household flour iron fortificationc
None 300 33.9 0.890
Insufficient 75 30.8

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Adequate 9 33.3
Child had inflammation
Yes 290 27.1 0.464
No 1098 29.7
Child vitamin A deficient
Yes 208 29.3 0.980
No 1180 29.2
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fuma-
rate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm

There is some evidence that children with vitamin A deficiency have a higher prevalence of investigated morbidities
two weeks prior to the survey, though this difference is only significant for lower respiratory infections and fever (see
Table 49). Moreover, children with elevated inflammation markers have a higher prevalence of vitamin A deficiency
compared to those without inflammation. None of the other investigated indicators are significantly associated with
vitamin A deficiency.

Table 50. Correlation between various factors and vitamin A deficiency in children 5-9 years of age, the
Kyrgyz Republic 2021

Characteristic N %a Vit A deficiency p-valueb

Child had diarrhea
Yes 35 8.3 0.376
No 1349 16.2
Child had fever
Yes 103 32.0 <0.005
No 1280 14.5
Child had lower respiratory infection
Yes 8 39.5 <0.05
No 1377 15.8
Child’s household had adequate sanitation
Yes 1164 16.0 0.890
No 215 16.5
Child’s household had safe drinking water
Yes 1345 8.7 0.266
No 36 16.3
Minimum dietary diversity
Yes 971 14.8 0.185
No 414 19.0
Consumed vitamin A rich foods
Yes 1051 15.0 0.175
No 334 19.4
Took vitamin A tablets in past 6 months
Yes 67 18.8 0.732
No 1310 16.0
Took multivitamin supplement in past 6 months
Yes 183 19.2 0.442
No 1193 15.6

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Child had inflammation

Yes 290 26.5 <0.005
No 1098 13.4
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Тест хи-квадрат; Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other

3.5. Adolescent girls

3.5.1. Characteristic

Table 50 describes the demographic characteristics of adolescent girls participating in the NIMAS. Overall,
there is a good representation of urban/rural residence and the regions, although there is a slightly smaller
proportion of adolescent girls from Bishkek. Further, there is an underrepresentation of older girls and an
overrepresentation of younger ones.

Table 51. Description of adolescent girls 10-18 years of age, the Kyrgyz Republic 2021

Adolescent girls in Kyrgyz

Characteristic N %a (95% CI)b
population (%) [63]
Age Group (in years)
10-12 428 42.0 (39.0, 45.0) 37
13-15 364 38.5 (35.4, 41.8) 33
16-18 204 19.5 (17.1, 22.2) 30
Residence
Urban 322 27.3 (24.3, 30.6) 30
Rural 674 72.7 (69.4, 75.7) 70
Region
Batken oblast 109 7.8 (6.3, 9.6) 8
Jalal-Abad oblast 126 19.2 (16.3, 22.4) 20
Issyk-Kul oblast 96 7.7 (6.5, 9.1) 8
Naryn oblast 158 7.2 (6.0, 8.7) 5
Osh oblast 141 22.3 (19.4, 25.6) 23
Talas oblast 109 5.1 (4.0, 6.5) 5
Chui oblast 103 18.7 (15.4, 22.4) 13
Bishkek city 51 7.4 (5.6, 9.7) 13
Osh city 103 4.7 (3.7, 5.9) 4
Wealth quintile
Lowest 291 26.9 (23.3, 30.9)
Second 224 23.9 (20.4, 27.8)
Middle 191 20.0 (17.0, 23.4)
Fourth 181 19.4 (15.9, 23.4)
Highest 105 9.8 (7.8, 12.2)
TOTAL 996
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.

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3.5.2. Recent illness and health indicators

Recent illnesses were uncommon in adolescent girls, which is also reflected in the low prevalence of elevated
inflammation markers. Only about 10% of girls have one or both of the evaluated inflammatory marker (AGP,
CRP) elevated, indicating some form of systemic inflammation (see Table 51).

Table 52. Health indicators in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Had lower acute respiratory infection in past 2 weeksc
Yes 8 1.0 (0.5, 2.2)
No 984 99.0 (97.8, 99.5)
Had diarrhea in past 2 weeks
Yes 54 5.3 (3.9, 7.2)
No 935 94.3 (92.4, 95.8)
Had fever in past 2 weeks
Yes 65 7.4 (5.6, 9.7)
No 925 92.3 (90.0, 94.1)
Inflammation d

None 719 88.3 (85.4, 90.7)

Early (High CRP, Normal AGP) 10 1.0 (0.5, 2.1)
Acute (High CRP, High AGP) 40 4.6 (3.3, 6.4)
Convalescent (Normal CRP, High AGP) 53 6.0 (4.4, 8.3)
Note: The N’s are the numerators for a specific sub-group. The percentages do not add up to 100% because the small proportion of the
respondents that reported ‘don’t know’ or ‘not applicable’ is not shown.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval calculated taking into account the complex sampling design.
c
Questions on recent illness were phrased according to the MICS manual [68].
d
For thresholds of inflammatory markers, refer to Thurnham et al [39].

3.5.3. Dietary diversity

As shown in Table 52 more than two-thirds of the adolescents consumed 5 or more food groups (out of a
possible 10 food groups) the day before the survey, and the mean dietary score was 6.4. Significant differences
were detected between the regions; while in Chui and Bishkek just about 50% of girls ate 5 or more food
groups, about 80% of girls living in Batken, Jalal Abad and Osh Oblast ate five or more food groups. Significant
differences were also observed by food security status, with a higher proportion of adolescent girls consuming
≥5 food groups as the household food security status improved.

Table 53. Dietary diversity in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021

Consumed 5+ food groups Mean dietary

Characteristic
N % a
(95% CI) b
p-value c score
Age Group (in years)
10-12 428 70.6 (65.4, 75.3) 0.541 6.5
13-15 364 67.2 (61.8, 72.2) 6.2
16-18 204 66.8 (58.6, 74.2) 6.5
Residence
Urban 322 63.0 (56.1, 69.5) 0.057 6.2
Rural 674 70.7 (66.1, 74.8) 6.5

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Region
Batken oblast 109 80.7 (68.5, 89.0) <0.001 7.1
Jalal-Abad oblast 126 83.4 (74.6, 89.7) 7.1
Issyk-Kul oblast 96 73.6 (63.2, 81.9) 6.7
Naryn oblast 158 59.8 (51.0, 68.1) 6.0
Osh oblast 141 79.8 (70.2, 86.9) 6.7
Talas oblast 109 59.6 (45.4, 72.4) 5.9
Chui oblast 103 46.7 (36.5, 57.1) 5.5
Bishkek city 51 51.6 (34.0, 68.8) 5.6
Osh city 103 63.0 (51.1, 73.6) 6.1
Wealth quintile
Lowest 291 65.0 (57.5, 71.8) 0.184 6.1
Second 224 68.3 (59.5, 76.0) 6.5
Middle 191 77.5 (69.6, 83.8) 6.7
Fourth 181 66.9 (56.7, 75.8) 6.2
Highest 105 62.5 (50.4, 73.2) 6.4
Household food security
Secure 602 75.9 (71.1, 80.2) <0.001 6.8
Mildly insecure 128 59.6 (49.1, 69.3) 6.0
Moderately insecure 184 58.0 (49.1, 66.3) 5.8
Severely insecure 78 49.0 (33.1, 65.1) 5.2
TOTAL 996 68.6 (64.8, 72.1) 6.4
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
с
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

3.5.4. Consumption of vitamins and supplements

As shown in Table 53 Only a small proportion of adolescent girls consumed dietary supplements in the past
six months prior to the survey: iron (6.2%), folic acid (3.7%), vitamin D (4.6%), vitamin A (3.7%), multivitamins
(8.8%), and very few were still taking supplements at the time of the survey.

Table 54. Consumption of mineral and vitamin supplements in adolescent girls 10-18 years of age, the Kyrgyz
Republic 2021

Characteristic N %a (95% CI)b

Took iron tablet or syrup in past 6 months
Yes 47 6.2 (4.2, 8.9)
No 940 92.8 (89.9, 94.9)
Don’t know 9 1.0 (0.5, 2.0)
Is still taking iron
Yes 10 20.8 (11.4, 34.8)
No 32 79.2 (65.2, 88.6)
Took folic acid supplements in past 6 months
Yes 28 3.7 (2.3, 5.9)
No 963 95.7 (93.6, 97.2)
Don’t know 5 0.5 (0.2, 1.5)

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Is still taking folic acid

Yes 5 19.0 (5.4, 49.3)
No 19 81.0 (50.7, 94.6)
Took vitamin D tablets or syrup in past 6 months
Yes 41 4.6 (3.2, 6.6)
No 947 94.4 (92.4, 95.9)
Don’t know 8 0.9 (0.4, 2.1)
Is still taking vitamin D tablets or syrup
Yes 7 13.8 (5.2, 32.0)
No 28 86.2 (68.0, 94.8)
Took vitamin A tablets or other preparations in past 6 months
Yes 29 3.7 (2.3, 5.9)
No 957 95.2 (93.0, 96.7)
Don’t know 10 1.1 (0.5, 2.2)
Is still taking vitamin A
Yes 2 6.9 (0.9, 37.6)
No 19 93.1 (62.4, 99.1)
Took multivitamin tablets or other preparations in past 6 months
Yes 86 8.8 (6.9, 11.3)
No 904 90.6 (88.1, 92.6)
Don’t know 6 0.6 (0.2, 1.4)
Is still taking multivitamins
Yes 30 31.5 (20.8, 44.6)
No 55 68.5 (55.4, 79.2)
Took fish oil supplements in past 6 months
Yes 40 4.2 (2.8, 6.2)
No 950 95.4 (93.3, 96.8)
Don’t know 6 0.4 (0.2, 1.1)
Is still taking fish oil supplements
Yes 14 35.1 (17.9, 57.3)
No 20 64.9 (42.7, 82.1)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.5.5. Short stature

Overall, the prevalence of short stature is below 3%. Significant differences were found by region: In Talas,
more than 10% of adolescents are of short stature, while no girl with short stature was found in Jalal Abad. No
significant associations were found between short stature and any other investigated indicator (see Table 54).

Figure 19 shows the distribution of the height-for-age z-score in the surveyed population of adolescent girls
10-18 years of age. The distribution of the height-for-age z-scores closely matches the WHO Child Growth
Standard.

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20
Percent of adolescent girls

15

10

0
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
Height-for-age Z score (HAZ)
WHO Growth reference Survey sample; SD=1.0

Figure 19. Distribution of height-for-age z-scores in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021

Table 55. Percentage of adolescent girls 10-18 years of age with short stature, the Kyrgyz Republic 2021

Characteristic N %a,b (95% CI)c p-valued

Age Group (in years)
10-12 372 2.8 (1.5, 5.2) 0.920
13-15 308 2.8 (1.4, 5.6)
16-18 174 3.4 (1.3, 9.0)
Residence
Urban 259 3.5 (1.7, 7.4) 0.548
Rural 595 2.7 (1.6, 4.4)
Region
Batken oblast 104 2.8 (0.6, 11.9) <0.05
Jalal-Abad oblast 112 0 (0, 0)
Issyk-Kul oblast 88 2.4 (0.6, 9.6)
Naryn oblast 156 1.2 (0.3, 4.6)
Osh oblast 121 3.5 (1.4, 8.5)
Talas oblast 84 11.1 (6.6, 18.2)
Chui oblast 63 4.6 (1.7, 12.0)
Bishkek city 34 2.6 (0.4, 16.2)
Osh city 92 3.2 (0.8, 12.2)
Wealth quintile
Lowest 262 2.4 (1.1, 5.1) 0.287
Second 202 2.2 (0.9, 5.6)
Middle 157 5.3 (2.4, 11.0)
Fourth 145 3.3 (1.1, 9.5)
Highest 85 0.6 (0.1, 4.2)

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Household food security

Secure 513 3.6 (2.2, 5.9) 0.193
Mildly insecure 112 1.6 (0.5, 5.1)
Moderately insecure 163 1.0 (0.3, 3.6)
Severely insecure 63 4.5 (1.2, 16.1)
Household sanitation g

Unadequate 119 5.4 (2.3, 12.2) 0.360

Adequate 730 2.5 (1.5, 4.2)
Safe drinking waterh
Yes 834 3.0 (2.0, 4.5) 0.637
No 17 0 (0, 0)
TOTAL 854 2.9 (1.9, 4.4)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Stunting is defined as having a height-for-age z-score below -2 standard deviations from the WHO Growth reference data for age 5-19
population median.
b
Percentages weighted for unequal probability of selection.
c
CI=confidence interval, calculated taking into account the complex sampling design
d
P-value <0.05 indicates that the variation in the values of the subgroup are significantly different from all other subgroups.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking.

3.5.6. Thinness, overweight and obesity

Thinness is highly uncommon, affecting only about 2% of adolescent girls. No significant associations were
found in the sub-group analyses, which could be owed to the small number of girls with thinness.

Overall, about 15% of adolescent girls are overweight or obese; with 4% classified as obese and 11% overweight.
Although not significant, the prevalence of obesity or overweight tends to increase with age. Further, a
significant association was found between overweight or obesity and household sanitation. The prevalence of
overweight or obesity is about 3 times higher in households without safe drinking water. The reason for this
is unclear, and may indicate that unsafe drinking water is a proxy for other characteristics associated with
overweight and obesity. However, the number of households without safe drinking water is small, thus results
will have to be interpreted with caution. No significant associations were found between overweight or obesity
and any of the other demographic factors.

105
 Table 56. Prevalence of thinness, overweight and obesity in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021

106
Thinnessd Overweightd Obesed Overweight или obese
Characteristic b c a b b
N % (95% CI) p-value % (95% CI) % (95% CI) % (95% CI)b p-valuec
Age (in years)
10-12 372 3.3 (1.6, 6.5) 0.205 7.5 (4.8, 11.5) 4.1 (2.3, 7.4) 11.6 (8.2, 16.3) 0.072
13-15 309 2.5 (1.0, 6.1) 10.7 (7.7, 14.6) 4.2 (2.4, 7.2) 14.9 (11.1, 19.6)
16-18 174 0 (0, 0) 19.1 (12.2, 28.6) 1.7 (0.5, 6.0) 20.8 (13.8, 30.2)
Residence
Urban 259 2.5 (1.0, 6.2) 0.900 11.6 (8.0, 16.5) 3.2 (1.5, 6.7) 14.8 (10.4, 20.6) 0.904
Rural 596 2.3 (1.2, 4.6) 10.6 (8.0, 13.8) 3.9 (2.5, 5.8) 14.4 (11.3, 18.3)
Region
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Batken oblast 104 3.3 (0.8, 13.2) 0.811 12.8 (7.8, 20.3) 2.8 (1.0, 7.8) 15.6 (10.0, 23.5) 0.687
Jalal-Abad oblast 112 2.3 (0.6, 8.7) 15.6 (10.7, 22.1) 2.4 (0.8, 6.7) 18.0 (12.5, 25.4)
Issyk-Kul oblast 89 1.1 (0.1, 7.5) 13.2 (7.5, 22.2) 6.6 (3.2, 13.0) 19.8 (11.8, 31.2)
Naryn oblast 156 1.8 (0.4, 7.0) 8.9 (5.5, 14.1) 2.3 (0.7, 7.3) 11.2 (7.4, 16.6)
Osh oblast 121 0.8 (0.1, 5.5) 9.5 (5.1, 16.9) 4.2 (1.9, 9.0) 13.7 (7.6, 23.5)
Talas oblast 84 3.6 (0.8, 15.6) 9.0 (4.9, 15.7) 3.0 (0.7, 11.3) 11.9 (6.4, 21.3)
Chui oblast 63 3.4 (0.9, 12.4) 5.4 (1.7, 15.6) 5.3 (2.2, 12.2) 10.7 (5.3, 20.5)
Bishkek city 34 3.5 (0.5, 20.4) 13.2 (5.3, 28.9) 1.9 (0.2, 14.0) 15.1 (6.7, 30.6)
Osh city 92 4.9 (1.9, 12.1) 10.8 (6.1, 18.3) 3.2 (1.2, 8.7) 14.0 (9.0, 21.1)
Wealth quintile
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Lowest 263 3.3 (1.2, 8.6) 0.670 11.6 (7.7, 17.2) 2.8 (1.2, 6.2) 14.4 (9.9, 20.4) 0.980
Second 202 1.3 (0.2, 6.7) 11.8 (7.7, 17.6) 2.3 (1.0, 5.5) 14.1 (9.7, 20.1)
Middle 157 1.9 (0.7, 5.1) 9.0 (5.3, 14.9) 4.6 (2.0, 10.1) 13.7 (8.7, 20.9)
Fourth 145 3.5 (1.2, 9.3) 11.2 (6.8, 17.8) 5.0 (2.1, 11.1) 16.1 (10.6, 23.7)
Highest 85 1.9 (0.6, 6.2) 9.9 (3.7, 24.2) 5.7 (1.8, 16.4) 15.7 (6.8, 32.3)
Household food security
Secure 514 1.7 (0.7, 3.7) 0.424 12.1 (9.1, 15.9) 3.4 (2.1, 5.4) 15.5 (12.0, 19.8) 0.878
Mildly insecure 112 3.3 (0.8, 12.7) 7.9 (3.7, 16.3) 4.8 (1.8, 12.5) 12.7 (6.5, 23.4)
Moderately insecure 163 2.7 (0.8, 8.7) 10.7 (5.9, 18.6) 3.8 (1.7, 8.0) 14.5 (9.1, 22.3)
Severely insecure 63 6.0 (1.6, 20.4) 7.5 (3.2, 16.6) 4.3 (0.9, 18.3) 11.8 (5.4, 23.7)
 Household sanitatione
Unadequate 119 3.1 (0.8, 10.8) 0.896 13.3 (7.2, 23.2) 4.0 (1.5, 10.5) 17.3 (10.8, 26.5) 0.692
Adequate 731 2.3 (1.3, 4.2) 10.6 (8.2, 13.4) 3.7 (2.5, 5.4) 14.3 (11.4, 17.7)
f
Safe drinking water
Yes 835 2.5 (1.4, 4.3) 0.658 10.3 (8.2, 12.9) 3.7 (2.5, 5.3) 14.0 (11.3, 17.1) <0.001
No 17 0 (0, 0) 36.0 (16.9, 60.8) 6.2 (1.5, 22.3) 42.2 (25.7, 60.5)
TOTAL 855 2.4 (1.4, 4.1) 10.8 (8.7, 13.5) 3.7 (2.6, 5.3) 14.5 (11.9, 17.7)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
P-value <0.05 indicates that at least one subgroup is significantly different from the others.
d
Thinness is defined as BMI-for-age z-score smaller than -2, overweight is defined as having a BMI-for-age z-score greater than +1 but less than or equal to +2 standard deviations and obesity is defined
as having a BMI-for-age z-score greater than +2 standard deviations from the WHO Growth reference data for age 5-19 population median.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another
household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking.

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.5.7. Anemia, Iron deficiency и Iron deficiency anemia

The distribution of hemoglobin values for adolescent girls is shown in Figure 20. Many adolescents are above
the cut-off defining anemia of 115 g/L for girls <12 years of age and 120g/L for girls ≥12 years of age. The
weighted median hemoglobin concentration is 131 g/L.

25
Percent of adolescent girls

20

15

10

0
30 50 70 90 110 130 150 170 190 210 230 250
Hemoglobin concentration (g/L)
Median: 131 g/L Survey sample

Figure 20. Distribution of adjusted hemoglobin (g/L) in adolescent girls 10-18 years of age, the Kyrgyz
Republic 2021

Figure 21 визуализирует долю девочек-подростков с одновременным Deficientом железа и анемией,

часто именуемым железоDeficientной анемией. Из рисунка видно, что у этих подростков почти все случаи
анемии сопровожYesются Deficientом железа.

13% 34%
2%
anemia iron Iron
only deficiency deficiency
anemia only

Figure 21. Venn diagram showing overlap between anemia and iron deficiency in adolescent girls 10-18 years
old age, the Kyrgyz Republic 2021

As shown in Table 56 below, about 15% of adolescent girls in the Kyrgyz Republic have anemia. The public
health significance at this prevalence would be classified as ‘mild’ by the WHO [36]. The prevalence of anemia
increases with age and is significantly higher in menarche than in pre-menarche girls. Anemia prevalence
would be classified as ‘moderate’ by WHO in girls aged 16-18 years and menarche girls. None of the other
investigated indicators are significantly associated with anemia.
Severe anemia is rare, below 1% in adolescent girls. About equal proportions of girls have moderate and mild
anemia (see Table 91).
Similar to anemia, ID and IDA are more common in older girls and menarche girls. None of the other investigated
factors are significantly associated with ID and IDA.

108
 Table 56. Prevalence of anemia, iron deficiency, and iron deficiency anemia in adolescent girls 10-18 years, by various demographic characteristics, the Kyrgyz
Republic 2021

Anemia Iron deficiencye Iron deficiency anemia

Characteristic a, b c d a c d
N % 95% CI p-value N % 95% CI p-value N %a, f 95% CIc p-valued
Age Group (in years)
10-12 374 7.7 (4.7, 12.1) <0.0005 353 29.3 (24.0, 35.3) <0.001 352 5.2 (3.1, 8.7) <0.0001
13-15 309 17.9 (13.1, 23.9) 297 56.9 (49.5, 64.0) 295 16.9 (12.2, 22.9)
16-18 175 24.1 (16.7, 33.6) 172 65.4 (55.9, 73.8) 172 21.3 (14.4, 30.2)
Menstruation
Pre-menarche 361 5.9 (3.4, 10.0) <0.0001 347 27.3 (21.2, 34.4) <0.001 345 4.6 (2.3, 8.8) <0.0001
Menarche 497 21.0 (16.9, 25.8) 475 61.3 (54.9, 67.3) 474 18.8 (14.9, 23.5)
Residence
Urban 262 14.9 (9.4, 22.7) 0.928 254 48.5 (39.8, 57.3) 0.609 253 10.8 (6.5, 17.3) 0.434
Rural 596 14.5 (11.1, 18.7) 568 45.7 (39.7, 51.9) 566 13.5 (10.1, 17.8)
Region
Batken oblast 104 15.9 (9.0, 26.5) 0.686 102 42.1 (31.8, 53.2) 0.813 100 15.5 (8.5, 26.8) 0.465
Jalal-Abad oblast 112 16.0 (9.6, 25.5) 103 44.6 (30.3, 59.9) 103 13.5 (7.2, 23.7)
Issyk-Kul oblast 89 16.7 (9.5, 27.8) 89 44.8 (35.0, 55.0) 89 11.9 (6.1, 21.8)
Naryn oblast 156 15.9 (10.9, 22.7) 150 48.4 (40.7, 56.1) 150 13.3 (9.1, 19.1)
Osh oblast 121 8.6 (4.7, 15.3) 113 43.4 (32.7, 54.9) 113 9.4 (5.1, 16.7)
Talas oblast 84 16.4 (9.1, 27.8) 81 59.1 (47.1, 70.1) 81 14.4 (7.8, 25.0)
Chui oblast 63 18.3 (9.1, 33.5) 61 48.4 (33.8, 63.3) 61 18.7 (9.3, 34.0)
Bishkek city 35 15.5 (5.0, 39.0) 35 53.5 (35.5, 70.6) 34 7.2 (2.2, 21.2)
Osh city 94 12.9 (7.1, 22.5) 88 43.8 (33.5, 54.8) 88 6.9 (3.2, 14.2)
Wealth quintile
Lowest 263 14.3 (9.8, 20.3) 0.746 255 52.5 (43.7, 61.2) 0.330 254 13.6 (8.9, 20.2) 0.104
Second 202 18.0 (12.4, 25.5) 197 49.1 (40.3, 58.0) 196 16.8 (11.3, 24.2)
Middle 157 14.6 (9.2, 22.5) 146 41.6 (31.3, 52.7) 145 14.3 (8.7, 22.7)
Fourth 147 12.5 (7.3, 20.5) 140 43.1 (32.4, 54.4) 140 10.0 (5.1, 18.5)
Highest 86 11.9 (4.4, 28.2) 81 37.6 (23.8, 53.8) 81 3.1 (0.8, 11.2)

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 Household food security

110
Secure 515 14.1 (10.6, 18.5) 0.266 491 47.7 (41.3, 54.1) 0.323 490 12.3 (9.0, 16.8) 0.176
Mildly insecure 112 10.7 (5.4, 20.2) 110 50.0 (38.6, 61.3) 110 10.9 (5.5, 20.5)
Moderately insecure 165 15.3 (8.9, 24.9) 160 39.3 (29.3, 50.2) 159 11.3 (6.3, 19.7)
Severely insecure 63 24.9 (13.9, 40.6) 58 53.5 (37.6, 68.7) 57 24.1 (13.2, 42.4)
Household sanitation в ДХg
Unadequate 119 10.2 (5.7, 17.8) 0.376 114 45.6 (34.2, 57.5) 0.670 114 8.7 (4.4, 16.5) 0.435
Adequate 734 15.4 (12.2, 19.4) 703 46.6 (41.3, 52.1) 700 13.5 (10.4, 17.4)
h
Safe drinking water
Yes 838 14.7 (11.7, 18.3) 0.946 802 46.1 (41.1, 51.1) 0.441 799 12.7 (9.9, 16.2) 0.702
No 17 15.1 (6.0, 33.4) 17 60.2 (25.4, 87.0) 17 15.1 (6.0, 33.4)
TOTAL 858 14.6 (11.6, 18.2) 822 46.5 (41.5, 51.6) 819 12.7 (9.9, 16.2)
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Note: The N’s are the denominators for a specific sub-group. For iron deficiency and iron deficiency anemia, the numbers are smaller than for anemia due to unsuccessful blood collection (sufficient
blood could be obtained only for the on-site analysis of hemoglobin concentration).
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Anemia defined as hemoglobin < 115 g/L for girls <12 years of age and < 120g/L for ≥12 years of age; hemoglobin adjusted for altitude
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Iron deficiency defined as inflammation adjusted plasma ferritin < 15 µg/L.
f
Iron deficiency anaemia defined as plasma ferritin < 15.0 μg/L and hemoglobin < 115 g/L (girls <12 years of age) or <120g/ L (girls ≥12 years of age).
g
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
hold. Inadequate sanitation = open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field
h
Composite variable of main source of drinking water and treating water to make safe for drinking.
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
 REPORT- OCTOBER 2022

3.5.8. Vit A deficiency

As shown in Table 57, about 7% of adolescent girls are vitamin A deficient, a prevalence classified as mild
public health problem according to WHO [71]. Vitamin A deficiency prevalence is significantly higher in pre-
menarche girls compared to menarche. Although not significant, the data indicates differences in prevalence by
region: The prevalence in Batken, Bishkek and Osh City poses a moderate public health problem. No significant
associations were found between vitamin A deficiency and any other investigated indicators.

Table 57. Prevalence of vitamin A deficiency in adolescent girls 10-18 years of age, by various demographic
characteristics, the Kyrgyz Republic 2021

Characteristic N %a with VADb (95% CI)c p-valued

Age Group (in years)
10-12 353 8.7 (6.0, 12.5) 0.472
13-15 297 5.8 (3.4, 9.6)
16-18 172 6.1 (2.5, 14.2)
Menstruation
Pre-menarche 347 10.4 (7.4, 14.6) <0.05
Menarche 475 4.5 (2.7, 7.6)
Residence
Urban 254 5.0 (2.4, 10.4) 0.260
Rural 568 7.9 (5.9, 10.4)
Region
Batken oblast 102 15.0 (8.8, 24.4) 0.180
Jalal-Abad oblast 103 3.5 (1.5, 8.2)
Issyk-Kul oblast 89 8.4 (4.5, 14.9)
Naryn oblast 150 4.6 (2.5, 8.2)
Osh oblast 113 7.4 (4.1, 12.9)
Talas oblast 81 4.9 (2.0, 11.4)
Chui oblast 61 6.3 (2.7, 14.3)
Bishkek city 35 9.5 (3.0, 36.7)
Osh city 88 9.1 (4.3, 18.5)
Wealth quintile
Lowest 255 8.6 (5.4, 13.4) 0.536
Second 197 7.3 (4.1, 12.5)
Middle 146 3.7 (1.6, 8.5)
Fourth 140 5.7 (2.6, 11.9)
Highest 81 9.1 (3.2, 23.1)
Household food security
Secure 491 6.5 (4.7, 9.1) 0.874
Mildly insecure 110 5.3 (1.9, 14.3)
Moderately insecure 160 8.0 (4.1, 15.1)
Severely insecure 58 8.2 (2.8, 22.2)
Household sanitation e

Unadequate 114 3.7 (1.5, 9.0) 0.381

Adequate 703 7.3 (5.5, 9.8)
Safe drinking water f

Yes 802 6.9 (5.2, 9.1) 0.788

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

No 17 5.6 (1.2, 21.8)

TOTAL 822 7.1 (5.4, 9.3)
Note: The N’s are the denominators for a specific sub-group; for VAD, the numbers are smaller than for anemia due to unsuccessful
blood collection (sufficient blood could only be obtained for the on-site analysis of hemoglobin concentration) or insufficient sample
volumes for retinol analysis.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
VAD = Vitamin A deficiency, defined as RBP adjusted for inflammation <0.569 umol/L.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking.

3.5.9. Folate deficiency

The prevalence of folate deficiency in Kyrgyz adolescent girls is very high, affecting more than 4 out of 5 girls
(see Table 58). Significant differences were found between pre-menarche and menarche girls with a higher
folate deficiency in menarche. Moreover, the data indicates differences by region, although differences are not
significant. While in Nary and Chui more than 9 out of 10 girls are folate deficient, the prevalence in Batken is
only 75%. No significant associations were detected between folate deficiency and age, urban/rural residence,
household wealth, household food security, household sanitation or household`s access to safe drinking water.

Table 58. Prevalence of folate deficiency in adolescent girls 10-18 years of age, by various demographic
characteristics, the Kyrgyz Republic 2021

Characteristic N %a with folate deficiencyb (95% CI)c p-valued

Age Group (in years)
10-12 353 80.5 (74.3, 85.5) 0.233
13-15 298 86.4 (80.6, 90.6)
16-18 173 85.3 (77.0, 91.0)
Menstruation
Pre-menarche 346 78.4 (71.6, 84.0) <0.05
Menarche 478 87.6 (82.7, 91.2)
Residence
Urban 256 83.6 (78.0, 88.0) 0.999
Rural 568 83.6 (78.7, 87.5)
Region
Batken oblast 104 75.6 (61.6, 85.7) 0.065
Jalal-Abad oblast 100 79.1 (70.9, 85.4)
Issyk-Kul oblast 90 86.9 (76.9, 93.0)
Naryn oblast 148 93.3 (84.3, 97.4)
Osh oblast 112 77.4 (66.3, 85.7)
Talas oblast 83 88.7 (77.3, 94.8)
Chui oblast 62 91.0 (77.8, 96.7)
Bishkek city 35 89.7 (74.5, 96.3)
Osh city 90 81.8 (68.9, 90.1)
Wealth quintile
Lowest 255 86.4 (80.5, 90.8) 0.274
Second 197 80.6 (72.1, 87.0)

112
 REPORT- OCTOBER 2022

Middle 146 78.5 (69.6, 85.4)

Fourth 141 87.9 (79.5, 93.2)
Highest 82 83.9 (71.4, 91.5)
Household food security
Secure 487 82.5 (77.6, 86.6) 0.670
Mildly insecure 111 87.1 (74.9, 93.9)
Moderately insecure 161 82.3 (72.9, 88.9)
Severely insecure 62 88.2 (76.6, 94.5)
Household sanitation в ДХ e

Unadequate 111 89.5 (80.8, 94.5) 0.090

Adequate 708 82.6 (78.4, 86.2)
Safe drinking water f

Yes 806 83.4 (79.6, 86.7) 0.846

No 15 85.1 (62.8, 95.1)
TOTAL 824 83.6 (79.8, 86.8)
Note: The N’s are the denominators for a specific sub-group; for VAD, the numbers are smaller than for anemia due to unsuccessful
blood collection (only sufficient blood could be obtained for the on-site analysis of hemoglobin concentration) or insufficient sample
volumes for retinol analysis.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Folate deficiency defined as plasma folate <10 nmol/L.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
f
Composite variable of main source of drinking water and treating water to make safe for drinking.

3.5.10. Vitamin D deficiency

Nationally about 40% of adolescent girls are vitamin D deficient or insufficient (see Table 59). Young girls have
a slightly lower prevalence than older girls. Moreover, the prevalence of vitamin D deficiency or insufficiency
is about twice as high in urban areas compared to rural areas. No statistically significant difference in the
prevalence of vitamin D deficiency and any other investigated indicator was detected.

Table 59. Prevalence of vitamin D deficiency in adolescent girls 10-18 years of age, by various demographic
characteristics, the Kyrgyz Republic 2021

Deficienta Insufficienta Deficient or insufficient

Characteristic
N b
% c
(95% CI) d
% c
(95% CI) d
% c
(95% CI)d p-valuee
Age Group (in years)
10-12 82 5.1 (1.7, 14.2) 23.7 (14.5, 36.2) 28.8 (18.4, 42.1) <0.05
13-15 72 6.5 (2.6, 15.5) 43.2 (31.8, 55.4) 49.7 (38.0, 61.5)
16-18 47 19.1 (10.1, 33.2) 23.8 (13.3, 38.8) 42.9 (28.9, 58.2)
Menstruation
Pre-menarche 84 5.3 (1.7, 15.1) 28.0 (17.9, 40.9) 33.3 (22.1, 46.7) 0.196
Menarche 117 11.0 (7.0, 17.1) 32.8 (24.4, 42.5) 43.8 (34.5, 53.7)
Residence
Urban 65 18.6 (11.6, 28.4) 38.6 (26.4, 52.5) 57.2 (42.0, 71.1) <0.01
Rural 136 4.8 (2.0, 11.0) 27.8 (20.5, 36.5) 32.6 (24.1, 42.3)

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Wealth quintile
Poorest 60 8.2 (2.7, 22.3) 27.0 (16.0, 41.9) 35.2 (22.6, 50.4) 0.735
Second 52 13.1 (6.2, 25.5) 29.8 (17.8, 45.3) 42.9 (27.3, 60.0)
Middle 35 5.0 (1.1, 20.1) 38.4 (23.3, 56.1) 43.4 (27.4, 60.8)
Fourth 35 4.2 (1.4, 11.8) 30.2 (15.6, 50.2) 34.4 (18.9, 54.2)
Wealthiest 18 18.5 (7.6, 38.7) 36.4 (15.4, 64.3) 54.9 (25.7, 81.1)
Household food security
Secure 116 10.0 (5.7, 17.1) 33.3 (24.4, 43.7) 43.4 (33.4, 53.9) 0.122
Mildly insecure 29 9.4 (2.1, 33.2) 43.5 (22.3, 67.4) 52.9 (32.0, 72.9)
Moderately
40 6.5 (2.3, 17.3) 17.3 (8.6, 31.5) 23.8 (12.8, 39.9)
insecure
Severely insecure 15 4.2 (0.5, 26.0) 35.7 (13.8, 65.8) 39.9 (16.3, 69.3)
Household sanitation f

Unadequate 26 7.3 (1.7, 26.8) 21.0 (9.0, 41.6) 28.3 (14.4, 48.1) 0.213
Adequate 174 8.9 (5.5, 14.0) 32.5 (25.3, 40.5) 41.3 (32.9, 50.3)
Safe drinking water g

Yes 197 9.0 (5.7, 13.8) 32.2 (25.4, 39.8) 41.2 (33.2, 49.6) 0.186
No 3 0 (0, 0) 0 (0, 0) 0 (0, 0)
TOTAL 201 8.6 (5.5, 13.2) 30.7 (24.3, 38.1) 39.3 (31.7, 47.5)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
Deficient <12 ng/mL; Insufficient 12-19.9 ng/mL. Vitamin D concentrations below the limit of detection (<9 ng/mL; n=10) were recoded
to 9 ng/mL.
b
25% sub-sample.
c
Percentages weighted for unequal probability of selection.
d
CI=confidence interval, calculated taking into account the complex sampling design.
e
Chi-square p-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
f
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
g
Composite variable of main source of drinking water and treating water to make safe for drinking.

3.5.11. Iodine deficiency

Table 60 presents the iodine status of non-pregnant adolescent girls. The national median urinary iodine
concentration (mUIC) is approximately 175 µg/L indicating an adequate iodine status. Significant differences
were only observed by menstruation status, but these differences do not indicate a different iodine status
categorization. Although not significant due to the small number of individuals, the data indicate that girls
living in households consuming non-iodized salt tend to have lower UIC levels than girls living in households
consuming inadequately and adequately iodized salt. In addition, the mUIC in all sub-groups investigated
indicate an adequate iodine status.

Table 60. Moderately insecure концентрация йоYes в моче среди девочек-подростков 10-18 лет,
Kyrgyzская Республика, 2021 год

Characteristic N Median UICa (95% CI)b p-valuec

Age Group (in years)
10-12 354 164.94 (156.85, 183.00) 0.159
13-15 287 183.01 (177.21, 202.97)
16-18 160 186.19 (167.69, 206.85)

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Menstruation
Menarche 458 188.43 (178.96, 200.06) <0.05
Pre-menarche 343 164.44 (158.31, 184.85)
Residence
Urban 233 176.63 (161.33, 192.08) 0.913
Rural 568 175.05 (172.43, 193.39)
Region
Batken oblast 105 171.87 (161.33, 209.04) 0.331
Jalal-Abad oblast 100 182.33 (164.48, 203.22)
Issyk-Kul oblast 90 221.50 (191.61, 254.76)
Naryn oblast 156 169.33 (154.25, 189.90)
Osh oblast 110 171.45 (148.15, 181.39)
Talas oblast 70 281.08 (181.30, 289.05)
Chui oblast 62 166.10 (133.24, 200.27)
Bishkek city 26 167.76 (106.33, 213.17)
Osh city 82 178.78 (154.82, 193.90)
Wealth quintile
Lowest 249 157.55 (151.99, 191.75) 0.547
Second 197 188.35 (168.06, 208.81)
Middle 147 168.19 (161.62, 195.06)
Fourth 132 184.16 (165.97, 203.52)
Highest 73 193.15 (162.53, 223.78)
Food secure
Secure 474 180.65 (174.31, 193.51) 0.923
Mildly insecure 106 191.52 (158.09, 215.43)
Moderately insecure 159 167.41 (157.06, 208.54)
Severely insecure 59 161.29 (143.37, 182.83)
Household salt iodization
None (<5 ppm) 13 112.49 (88.87, 136.43) 0.811
Insufficient (5-14.9 ppm) 222 181.49 (163.37, 199.61)
Adequate (15+ ppm) 532 185.02 (174.81, 195.63)
Household sanitationd
Unadequate 104 164.28 (148.96, 198.41) 0.396
Adequate 692 175.80 (173.94, 191.74)
Safe drinking watere
Yes 784 175.69 (172.74, 191.05) 0.425
No 14 172.92 (95.07, 252.98
TOTAL 801 175.05 (172.09, 189.55)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a Medians are weighted for unequal selection probability; UIC = urinary iodine concentration.
b CI=confidence interval calculated by bootstrapping without taking into account the complex sampling design. Actual confidence inter-
vals probably narrower.
c Chi-square p-value <0.05 indicates that the mean of the natural log of urinary iodine concentration in at least one subgroup is statis-
tically significantly different from the values in the other subgroups.
d Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
e Composite variable of main source of drinking water and treating water to make safe for drinking.

Figure 22 shows the geographic distribution of median urinary iodine concentration by stratum.

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Bishkek city
Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city Median urinary iodine

concentration (μg/L)
Osh oblast 150 - 174
175 - 199
Batken oblast
200 - 224
225 - 249
250 - 299

Figure 22. Geographic distribution of median urinary iodine concentration in adolescent girls, the Kyrgyz
Republic 2021

3.5.12. Associations between micronutrient deficiencies and various factors

No indicators of recent morbidity are statistically significantly associated with anemia (Table 61) in adolescent
girls. Moreover, none of the household indicators are significantly associated with anemia. Reported
consumption of iron or multivitamin supplements is also not associated with anemia in adolescent girls.
However, the consumption of folate supplements is significantly associated with anemia, with girls that
consumed folate supplements having a substantially lower prevalence of anemia. Inflammation is also
significantly associated with anemia, and girls with inflammation have a lower anemia prevalence compared
to girls without inflammation. Of the measured micronutrient deficiencies, only iron deficiency is highly
significantly associated with anemia. An association, albeit non-significant, was found between anemia and
vitamin A deficiency, with a higher anemia prevalence found in girls with vitamin A deficiency.

Table 61. Correlation between various factors and anemia in adolescent girls 10-18 years of age, the Kyrgyz
Republic 2021

Characteristic N %a Anemia p valueb

Girl had diarrhea
Yes 50 16.9 0.664
No 805 14.4
Girl had fever
Yes 55 16.9 0.637
No 800 14.1
Girl had lower respiratory infection
Yes 7 6.1 0.364
No 849 14.6
Girl’s household had adequate sanitation
Yes 734 15.4 0.166
No 119 10.2

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Girl’s household had safe drinking water

Yes 838 14.7 0.946
No 17 15.1
Minimum dietary diversity
Yes 587 13.4 0.232
No 271 17.2
Took iron tablet or syrup in past 6 months
Yes 39 13.9 0.931
No 812 14.5
Took folate supplements in past 6 months
Yes 21 1.3 <0.01
No 832 15.2
Took multivitamin supplements in past 6 months
Yes 77 16.3 0642
No 777 14.5
Consumes coffee or tea during or directly after meal
Yes 704 15.6 0.152
No 154 9.9
Household flour iron fortification c

None 192 16.7 0.811

НеAdequate 56 13.7
Adequately fortified 1 0
Girl had inflammation
Yes 103 8.1 <0.05
No 716 14.7
Girl iron deficient
Yes 391 26.9 <0.001
No 428 2.2
Girl vitamin A deficient
Yes 58 22.8 0.066
No 761 13.2
Girl folate deficient
Yes 700 14.1 0.667
No 125 12.5
Girl vitamin D statusd
Normalльный 105 13.2
Insufficient 72 19.3
Deficient 23 29.5
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous
fumarate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm.
d
Vitamin D deficiency measured in a 25% sub-sample of adolescent girls.

Of the morbidity conditions included in the survey, only lower respiratory infection is statistically significantly
associated with ID (Table 62), and this association was negative. No significant association was found between
ID and any other investigated indicator.

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Table 62. Correlation between various factors and iron deficiency in adolescent girls 10-18 years of age, the
Kyrgyz Republic 2021

Characteristic N %a Iron deficiency p valueb

Girl had diarrhea
Yes 50 48.9 0.785
No 770 46.3
Girl had fever
Yes 54 35.3 0.155
No 766 47.5
Girl had lower respiratory infection
Yes 7 3.1 <0.001
No 814 47.3
Girl’s household had adequate sanitation
Yes 703 46.6 0.868
No 114 45.6
Girl’s household had safe drinking water
Yes 802 46.1 0.441
No 17 60.2
Minimum dietary diversity
Yes 555 46.4 0.963
No 267 46.7
Took iron tablets or syrup in past 6 months
Yes 36 47.1 0.923
No 779 46.2
Took multivitamin supplements in past 6 months
Yes 76 50.6 0.577
No 742 46.0
Consumes coffee or tea during or directly after meal
Yes 674 47.9 0.225
No 148 39.7
Household flour iron fortification c

None 183 43.4 0.542

Insufficient 54 42.6
Adequate 1 100.0
Girl had inflammation
Yes 103 36.9 0.094
No 719 47.8
Girl vitamin A deficient
Yes 59 46.1 0.954
No 763 46.5
Girl folate deficient
Yes 685 47.6 0.383
No 125 42.2
Girl vitamin D status d

Normal 104 38.7 0.104

Insufficient 72 53.1
Deficient 23 63.1

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Note: The N’s are the denominators for a specific sub-group.

a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fu-
marate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm
d
Vitamin D deficiency measured in a 25% sub-sample of adolescent girls

Vitamin A deficiency prevalence is significantly correlated with inflammation (see Table 63). The prevalence
of vitamin A deficiency is five times higher in adolescent girls with elevated inflammation markers compared
to those without inflammation. Moreover, though not significant, most likely due to the small number of
adolescent girls with illnesses, the data suggests that a larger proportion of girls with diarrhea or fever have
vitamin A deficiency compared to those without.

Table 63. Correlation between various factors and vitamin A deficiency in adolescent girls 10-18 years of age,
the Kyrgyz Republic 2021
Characteristic N %a Vit A deficiency p valueb
Girl had diarrhea
Yes 50 16.7 0.061
No 770 6.5
Girl had fever
Yes 54 11.4 0.169
No 766 6.4
Girl had lower respiratory infection
Yes 7 5.3 0.786
No 814 7.2
Girl’s household had adequate sanitation
Yes 703 7.3 0.149
No 114 3.7
Girl’s household had safe drinking water
Yes 802 6.9 0.788
No 17 5.6
Minimum dietary diversity
Yes 555 8.1 0.208
No 267 5.2
Took vitamin A tablets in past 6 months
Yes 25 0 0.219
No 788 7.2
Took multivitamin supplements in past 6 months
Yes 76 5.0 0.537
No 742 7.4
Girl had inflammation
Yes 103 25.5 <0.001
No 719 4.5
Girl folate deficient
Yes 685 6.4 0.140
No 125 11.2
Girl vitamin D status c

Normal 104 11.2 0.337

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Insufficient 72 8.3
Deficient 23 0
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Vitamin D deficiency measured in a 25% sub-sample of adolescent girls

Folate deficiency in adolescent girls is significantly associated with minimum dietary diversity, with a larger
proportion of girls being folate deficient who did not eat at least 5 food groups the day before the survey.
Moreover, of the morbidity conditions included in the survey, only diarrhea is statistically significantly associated
with folate deficiency (Table 64), and this association is negative. None of the other sub-group analyses yielded
any significant associations.

Table 64. Correlation between various factors and folate deficiency in adolescent girls 10-18 years of age, the
Kyrgyz Republic 2021
Characteristic N %a Folate deficiency p valueb
Girl had diarrhea
Yes 50 66.0 <0.05
No 773 84.7
Girl had inflammation
Yes 54 89.1 0.303
No 769 83.0
Girl had lower respiratory infection
Yes 7 94.7 0.244
No 817 83.4
Girl’s household had adequate sanitation
Yes 708 82.6 0.136
No 111 89.5
Girl’s household had safe drinking water
Yes 806 83.4 0.846
No 15 85.1
Minimum dietary diversity
Yes 558 80.7 <0.05
No 266 89.5
Took folate supplements in past 6 months
Yes 20 76.8 0.333
No 799 84.2
Took multivitamin supplements in past 6 months
Yes 76 82.7 0.851
No 744 83.6
Household flour iron fortification
None 183 82.1 0.627
Insufficient 54 75.7
Adequate 1 100
Girl had inflammation
Yes 100 83.7 0.959
No 710 83.4

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Girl vitamin D statusd

Normal 103 87.7 0.828
Insufficient 73 84.2
Deficient 23 85.0
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fu-
marate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm
d
Vitamin D deficiency measured in a 25% sub-sample of adolescent girls.

As shown in Table 65, no significant correlations were found between vitamin D deficiency and any of the
investigated indicators.

Table 65. Correlation between various factors and vitamin D deficiency in adolescent girls 10-18 years of age,
The Kyrgyz Republic 2021
%a Vitamin D deficient or
Characteristicc N p valueb
insufficient
Girl had diarrhea
Yes 15 27.8 0.363
No 186 40.2
Girl had inflammation
Yes 16 25.6 0.228
No 185 41.2
Girl had lower respiratory infection
Yes 2 0 0.277
No 199 40.9
Girl’s household had adequate sanitation
Yes 174 41.3 0.213
No 26 28.3
Girl’s household had safe drinking water
Yes 197 41.2 0.186
No 3 0
Minimum dietary diversity
Yes 138 41.1 0.541
No 63 35.7
Took multivitamin supplements in past 6 months
Yes 22 58.8 0.146
No 176 37.4
Took vitamin D supplements in past 6 months
Yes 7 61.4 0.255
No 191 38.9
Girl had inflammation
Yes 24 30.5 0.426
No 175 40.0
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P-value <0.05 indicates that the groups are statistically significantly different from each other
c
Vitamin D deficiency measured in a 25% sub-sample of adolescent girls.

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3.6. All females 15-49 years of age

3.6.1. Pregnancy and birth history

Table 66 below shows the distribution of pregnancy related variables among all females 15-49 years of age.
About every tenth participating female was pregnant and about one-quarter of them was breastfeeding at the
time of the survey. One-quarter of the surveyed females have never been pregnant, and about 20% of women
had 5 or more pregnancies. Almost 60% of females took iron or folic acid supplements and about 13% vitamin
A supplements during their last pregnancy.

Table 66. Distribution of pregnancy and birth variables in all females 10-49 years of age, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Currently Pregnant
Yes 176 11.6 (10.0, 13.6)
No 1315 87.1 (85.0, 88.9)
Don’t know 16 1.3 (0.7, 2.3)
Currently lactating c

Yes 243 23.2 (20.6, 26.0)

No 831 76.8 (74.0, 79.4)
Number of pregnancies
0 389 26.0 (23.8, 28.4)
1 137 9.9 (8.3, 11.7)
2 189 13.2 (11.4, 15.4)
3 230 14.9 (12.8, 17.3)
4 219 14.3 (12.5, 16.3)
5+ 332 21.8 (19.7, 24.0)
Number of births (live and still)
0 44 4.4 (3.2, 6.1)
1 161 15.2 (12.9, 17.8)
2 236 21.7 (18.9, 24.7)
3 269 23.5 (20.5, 26.7)
4 238 21.7 (19.1, 24.6)
5+ 159 13.5 (11.4, 16.0)
Took iron or folic acid supplements during last or current pregnancy
Yes 79 59.8 (49.3, 69.4)
No 48 36.6 (27.2, 47.1)
Don’t know 4 3.6 (1.2, 10.4)
Took vitamin A capsules during last or current pregnancy
Yes 148 13.5 (11.3, 16.2)
No 872 81.5 (78.5, 84.1)
Don’t know 54 5.0 (3.6, 6.9)
TOTAL 1507
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Adolescent girls and women that a) had not yet had menarche, b) had never been pregnant, or c) were pregnant but had never delivered
a child were excluded from the analysis of current breastfeeding.

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3.7. Non-pregnant women of reproductive age

3.7.1. Characteristic

Table 67 describes the demographic characteristics of non-pregnant women participating in the NIMAS. About
two-thirds of non-pregnant women included in the survey sample are from rural areas. About four out of five
women completed secondary school or higher. Most of the women are married and about one-quarter was
breastfeeding at the time of the survey. Systematic inflammation is present in about 15% of women, indicating
overall a low level of infection.

Table 67. Description of non-pregnant women 15-49 years of age, the Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Age Group (in years)
15-19 337 23.8 (21.5, 26.3)
20-29 300 22.0 (19.6, 24.7)
30-39 421 30.8 (27.8, 33.9)
40-49 327 23.3 (20.9, 25.9)
Residence
Urban 556 35.7 (33.3, 38.1)
Rural 829 64.3 (61.9, 66.7)
Region
Batken oblast 149 7.5 (6.4, 8.7)
Jalal-Abad oblast 163 17.4 (15.6, 19.4)
Issyk-Kul oblast 130 7.5 (6.4, 8.8)
Naryn oblast 151 4.9 (4.2, 5.7)
Osh oblast 173 18.8 (16.9, 20.8)
Talas oblast 153 5.1 (4.5, 5.7)
Chui oblast 136 17.3 (15.4, 19.3)
Bishkek city 162 16.2 (14.3, 18.3)
Osh city 168 5.4 (4.5, 6.5)
Wealth quintile
Lowest 307 19.7 (17.1, 22.7)
Second 303 21.8 (19.0, 24.9)
Middle 264 21.2 (18.5, 24.2)
Fourth 280 20.8 (17.7, 24.3)
Highest 227 16.5 (13.6, 19.8)
Educational level
Basic secondary or less 301 22.2 (19.7, 24.9)
Complete secondary or more 1016 77.8 (75.1, 80.3)
Marital Status
Currently not married 468 33.9 (31.2, 36.7)
Currently married 917 66.1 (63.3, 68.8)
Currently breastfeeding a child
Yes 239 26.2 (23.3, 29.3)
No 696 73.8 (70.7, 76.7)
Inflammation c

None 964 84.3 (81.7, 86.5)

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Early (High CRP, Normal AGP) 58 4.7 (3.5, 6.2)

Acute (High CRP, High AGP) 52 4.5 (3.3, 6.2)
Convalescent (Normal CRP, High AGP) 75 6.6 (5.1, 8.5)
TOTAL 1385
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
For thresholds of inflammatory markers, see Thurnham et al [39].

3.7.2. Dietary diversity

As described in Table 68, non-pregnant women consumed, on average, more than 6 food groups in the 24 hours
prior to the interview. About 70% met the minimum dietary diversity by eating at least 5 food groups during
this period. The mean number of food groups significantly differed by urban/rural residence and between the
regions. Significantly more women in rural areas were meeting minimum dietary diversity than women living
in urban centers. Meeting minimum dietary diversity was most common in Batken, Jalal Abad and Osh Oblast.
Meanwhile, fewer women were meeting minimum dietary diversity in Chui, Bishkek and Osh City. Regarding
food security status, a dose-response relationship is observed, with the proportion of women achieving
minimum dietary diversity increasing as household food security status improves.

Table 68. Dietary diversity in non-pregnant women 15-49 years of age, the Kyrgyz Republic 2021

Consumed 5+ food groups

Characteristic Mean dietary score
N %a (95% CI)b p-valuec
Age Group (in years)
15-19 337 64.2 (57.9, 70.0) 0.219 6.2
20-29 300 71.1 (64.7, 76.8) 6.5
30-39 421 70.3 (65.4, 74.7) 6.5
40-49 327 72.3 (66.3, 77.5) 6.6
Residence
Urban 556 65.5 (60.3, 70.3) <0.05 6.2
Rural 829 71.7 (68.6, 74.6) 6.6
Region
Batken oblast 149 81.2 (70.6, 88.6) <0.001 7.2
Jalal-Abad oblast 163 81.2 (73.6, 86.9) 7.3
Issyk-Kul oblast 130 75.2 (66.4, 82.3) 6.8
Naryn oblast 151 63.2 (52.9, 72.4) 6.2
Osh oblast 173 81.3 (74.3, 86.7) 6.9
Talas oblast 153 67.0 (58.1, 74.8) 6.1
Chui oblast 136 52.9 (46.7, 59.1) 5.6
Bishkek city 162 58.6 (50.2, 66.5) 5.9
Osh city 168 60.1 (52.8, 66.9) 5.9
Wealth quintile
Lowest 307 62.4 (55.7, 68.6) 0.080 6.3
Second 303 70.0 (62.9, 76.2) 6.5
Middle 264 74.5 (67.7, 80.3) 6.7
Fourth 280 73.0 (66.7, 78.5) 6.5
Highest 227 65.9 (57.8, 73.1) 6.2

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Household food security

Secure 924 74.9 (71.8, 77.8) <0.001 6.7
Mildly insecure 139 65.5 (55.2, 74.5) 6.2
Moderately insecure 240 57.6 (51, 63.9) 5.8
Severely insecure 78 46.1 (32.1, 60.7) 5.3
TOTAL 1385 69.5 (66.8, 72.0) 6.5
Note: The N’s are the denominators for a specific sub-group.

3.7.3. Consumption of vitamins and supplements

As shown in Table 69, the consumption of vitamin and mineral supplements is very low in the Kyrgyz Republic:
About only one out of ten women had taken iron, folic acid, vitamin D and/or multivitamin supplements in the
past six months prior to the survey and very few were still taking those supplements at the time of the survey.

Table 69. Consumption of vitamin and mineral supplements in non-pregnant women 15-49 years of age, the
Kyrgyz Republic 2021

Characteristic N %a (95% CI)b

Took iron tablets or syrup in past 6 months
Yes 147 11.1 (9.1, 13.5)
No 1228 88.3 (85.9, 90.4)
Don’t know 10 0.6 (0.3, 1.2)
Is still taking iron
Yes 46 26.9 (20.3, 34.7)
No 101 73.1 (65.3, 79.7)
Took folic acid supplements in past 6 months
Yes 119 9.3 (7.7, 11.0)
No 1256 90.1 (88.2, 91.7)
Don’t know 10 0.7 (0.3, 1.4)
Is still taking folic acid
Yes 35 27.6 (20.5, 36.1)
No 84 72.4 (63.9, 79.5)
Took vitamin D tablets or syrup in past 6 months
Yes 105 8.2 (6.7, 10.1)
No 1267 91.1 (89.2, 92.7)
Don’t know 13 0.7 (0.3, 1.3)
Is still taking vitamin D tablets or syrup
Yes 39 32.1 (22.2, 44.0)
No 66 67.9 (56.0, 77.8)
Took vitamin A tablets or other preparations in past 6 months
Yes 92 7.5 (5.8, 9.5)
No 1279 91.5 (89.4, 93.2)
Don’t know 14 1.0 (0.6, 1.8)
Is still taking vitamin A
Yes 24 25.7 (16.1, 38.3)
No 63 74.3 (61.7, 83.9)

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Took multivitamin tablets or other preparations in past 6 months

Yes 157 12.6 (10.4, 15.2)
No 1214 86.5 (83.9, 88.8)
Don’t know 14 0.9 (0.5, 1.6)
Is still taking multivitamins
Yes 51 29.3 (22.3, 37.5)
No 105 70.7 (62.5, 77.7)
Took fish oil supplements in past 6 months
Yes 84 6.5 (5.0, 8.5)
No 1291 93.0 (91.0, 94.5)
Don’t know 10 0.5 (0.3, 1.1)
Is still taking fish oil supplements
Yes 35 35.3 (22.8, 50.2)
No 47 64.7 (49.8, 77.2)
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.7.4. Anthropometry

The prevalence of undernutrition and overweight/obesity, as measured by body mass index, is shown in Table 70
and Figure 23 below. The prevalence of undernutrition and overweight/obesity by age is shown in Figure 24 and the
distribution of BMI is shown in Figure 25.

Relatively few women are underweight, about one-half have a normal BMI, about one-quarter of women are
overweight, and 17% are obese. Although undernutrition is somewhat present in Kyrgyz women, almost all women
with low BMI had BMIs between 17.0-18.4 and as such, were only considered “at risk” for chronic energy deficiency.

27,2%

Overweight

49,9% Obesity

Underweight

17,0% Normal weight

5,9%

Figure 23. Prevalence of underweight, normal weight, overweight and obesity in non-pregnant women 15-49
years of age, the Kyrgyz Republic 2021

On the other hand, overweight and obesity are very common in Kyrgyz women and increase with age (Figure
24). In the youngest age group only about 10% of women are overweight or obese, increasing up to about 77%
in women 45-49 years of age. Women living in rural areas are more likely to be overweight or obese compared
to those living in urban centers. Moreover, the prevalence of overweight or obesity is significantly higher in
married women than in women who are not married. Also, women with a higher education level are statistically
significantly more likely to be overweight or obese than women with a lower educational level (see Table 70).

126
 REPORT- OCTOBER 2022

15-19
20-24
Woman's age 25-29
30-34
35-39
40-44
45-49
0 20 40 60 80 100
Percent of non-pregnant women by age

Underweight Normal weight

Overweight Obesity

Figure 24. Prevalence of underweight, normal weight, overweight, and obesity in non-pregnant women 15-49
years of age, by age group, the Kyrgyz Republic 2021

As shown in Figure 25 the median BMI of women aged 15-49 years is 24.3, while the mean BMI is above 25 (see
Table 70).

10
Percent of non-pregnant

8
women 15-49y

0
10 15 20 25 30 35 40 45 50 55
Body mass index (BMI)

Median: 24,3 Survey sample

Figure 25. Distribution of BMI values in non-pregnant women 15-49 years of age, The Kyrgyz Republic 2021

127
 Table 70. Prevalence of low and high BMI in non-pregnant women 15-49 years of age, by various demographic characteristics, the Kyrgyz Republic 2021a

128
Низкая масса телаb % Overwt
% %
Characteristic N % % Obeseb or obesity p valuec
Mean BMI % Severe % At risk % Any Normalb Overwtb
Moderate (BMI ≥25)b
Age Group (in years)
15-19 280 21.9 1.0 0.9 10.1 12.0 77.6 9.4 1.0 10.4 <0.001
20-29 258 24.0 0.4 1.1 3.5 5.0 57.8 28.7 8.6 37.3
30-39 366 26.4 0.5 1.0 4.5 6.0 42.0 35.7 16.3 52.0
40-49 285 28.8 0 0 0.6 0.6 28.4 30.5 40.5 71.0
Residence
Urban 463 25.3 0.2 1.2 5.9 7.3 54.7 23.8 14.2 38.0 <0.05
Rural 726 25.6 0.6 0.5 3.8 4.9 47.2 29.2 18.6 47.9
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Region
Batken oblast 136 26.4 0 0.6 2.8 3.5 52.5 30.2 13.8 44.1 0.251
Jalal-Abad oblast 142 25.7 0 1.6 2.4 4.0 45.3 33.3 17.4 50.7
Issyk-Kul oblast 121 24.4 0 0 5.8 5.8 56.7 24.9 12.5 37.5
Naryn oblast 147 23.9 1.2 0.6 4.5 6.3 57.3 28.1 8.3 36.4
Osh oblast 150 25.7 0.7 0.8 3.9 5.4 46.1 25.9 22.7 48.5
Talas oblast 120 26.2 1.1 0 3.8 4.9 44.7 29.9 20.4 50.3
Chui oblast 93 24.9 1.0 0 8.7 9.7 48.2 24.0 18.0 42.0
Bishkek city 129 25.8 0 1.6 3.5 5.0 57.4 24.1 13.5 37.6
Osh city 151 25.5 0.5 0.5 4.3 5.3 47.1 28.5 19.0 47.5
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Wealth quintile
Lowest 277 24.8 0.1 0 6.0 6.2 52.6 27.5 13.7 41.2 0.202
Second 264 25.5 1.7 1.4 4.3 7.4 45.1 29.6 17.9 47.5
Middle 226 26.0 0 0.3 1.9 2.2 48.0 30.7 19.0 49.8
Fourth 231 25.4 0.1 0.7 7.1 7.9 48.8 23.6 19.6 43.2
Highest 187 25.6 0.2 1.6 3.4 5.2 58.4 23.4 13.0 36.4
 Educational level
Basic secondary or
258 23.3 1.0 1.0 11.9 13.8 65.7 11.6 8.9 20.5 <0.001
less
Complete secondary
882 26.1 0.3 0.7 2.4 3.5 45.7 31.7 19.2 50.8
or more
Marital Status
Currently not married 390 23.9 1.0 0.5 8.2 9.7 63.9 14.3 12.0 26.3 <0.001
Currently married 799 26.3 0.2 0.9 2.8 3.8 43.0 33.6 19.5 53.1
Currently lactating
Yes 210 25.7 0.2 1.5 2.0 3.7 45.4 35.5 15.4 50.9 0.381
No 609 26.7 0.1 0.6 3.3 3.9 41.1 32.0 23.0 55.0
TOTAL 1189 25.5 0.5 0.8 4.6 5.8 49.9 27.2 17.0 44.3
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Severe undernutrition defined as BMI <16.0; moderate undernutrition defined as BMI 16.0-16.9; at risk of undernutrition defined as BMI 17.0-18.4; normal weight defined as BMI 18.5 – 24.9;
overweight defined as BMI 25.0-29.9; obesity defined as BMI >30.
c
P value <0.05 indicates that one subgroup is significantly different from the other.

129
REPORT- OCTOBER 2022
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

3.7.5. Anemia, Iron deficiency и Iron deficiency anemia

As shown in Table 71, about 25% of non-pregnant women in the Kyrgyz Republic are anemic. Less than 1%
of non-pregnant women are severely anemic, whereas moderate and mild anemia are present in 11.3% and
13.1% of women, respectively (see Table 92 in appendix 8.5). Overall median hemoglobin in non-pregnant
women is 128g/L. The distribution of hemoglobin concentration is shown in Figure 26, showing that most
measurements are greater than the anemia cut-off of 120 g/L.

20
Percent of non-pregnant

15
women 15-49y

10

0
40 60 80 100 120 140 160 180 200 220 240
Hemoglobin concentration (g/L)
Median: 128 g/L Survey sample

Figure 26. Distribution of adjusted hemoglobin (g/L) in non-pregnant women 15-49 years of age, the Kyrgyz
Republic 2021

Figure 27 illustrates the overlap between anemia and ID in non-pregnant women, showing a very large overlap
between anemia and ID.

23% 31%
2% iron iron
anemia deficiency deficiency
only anemia only

Figure 27. Venn diagram showing overlap between anemia and iron deficiency in non-pregnant women 15-49
years of age, the Kyrgyz Republic 2021

As shown in Table 71, more than half of the women in the Kyrgyz Republic have ID and about one-quarter
IDA. While none of the investigated demographic indicators are significantly associated with anemia and IDA
prevalence, the prevalence of ID significantly differs by age: young women have the highest and women aged
40-49 years the lowest prevalence of ID. Significant differences in ID were also found by household wealth and
ID was highest in women living in the poorest households.

130
 Table 71. Prevalence of anemia, iron deficiency, and iron deficiency anemia in non-pregnant women 15-49 years of age, by various demographic characteristics,
the Kyrgyz Republic 2021.

Anemiab Iron deficiency e Iron deficiency anemia f

Characteristic c d a c d
N %a 95% CI p-value N % 95% CI p-value N %a 95% CIc p-valued
Age Group (in years)
15-19 281 28.0 (22.3, 34.7) 0.289 273 63.0 (56.5, 69.1) <0.001 273 26.2 (20.3, 33.1) 0.190
20-29 262 22.5 (16.9, 29.5) 251 56.9 (48.9, 64.5) 249 20.8 (15.2, 27.8)
30-39 375 27.8 (22.7, 33.5) 356 60.2 (53.7, 66.4) 355 25.8 (20.6, 31.8)
40-49 285 22.0 (16.8, 28.1) 269 42.1 (34.5, 50.0) 268 18.7 (14.1, 24.5)
Residence
Urban 471 25.0 (20.2, 30.4) 0.875 454 58.2 (51.6, 64.5) 0.388 453 22.7 (18.1, 28.2) 0.854
Rural 732 25.5 (21.6, 29.8) 695 54.5 (49.3, 59.7) 692 23.3 (19.5, 27.7)
Region
Batken oblast 140 32.8 (25.4, 41.3) 0.107 132 60.9 (52.4, 68.8) 0.132 131 32.9 (25.6, 41.0) 0.280
Jalal-Abad oblast 145 23.1 (15.1, 33.6) 134 47.8 (36.6, 59.2) 134 18.3 (11.2, 28.5)
Issyk-Kul oblast 120 34.8 (24.8, 46.3) 121 56.9 (48.1, 65.4) 119 27.6 (18.0, 39.9)
Naryn oblast 147 32.5 (24.2, 42.2) 145 57.7 (48.2, 66.8) 145 27.0 (19.3, 36.3)
Osh oblast 150 17.4 (11.7, 25.0) 144 47.2 (39.4, 55.1) 144 17.6 (11.7, 25.7)
Talas oblast 123 32.1 (23.2, 42.6) 113 62.9 (52.5, 72.2) 113 28.1 (19.6, 38.5)
Chui oblast 93 23.8 (16.4, 33.3) 91 61.0 (46.2, 74.0) 90 23.6 (16.0, 33.2)
Bishkek city 133 26.1 (18.4, 35.6) 127 62.7 (53.1, 71.4) 127 25.0 (17.1, 35.1)
Osh city 152 26.7 (19.9, 34.8) 142 55.7 (46.1, 64.8) 142 21.8 (15.5, 29.8)
Wealth quintile
Lowest 279 28.4 (22.7, 35.0) 0.103 267 64.5 (57.3, 71.2) <0.05 267 26.4 (20.7, 33.1) 0.209
Second 266 31.6 (25.0, 39.1) 259 55.7 (48.4, 62.8) 256 28.0 (22.0, 34.9)
Middle 228 20.7 (14.6, 28.6) 219 45.5 (37.7, 53.6) 218 19.1 (13.1, 26.9)
Fourth 235 23.9 (18.0, 31.1) 217 57.7 (48.2, 66.7) 217 22.0 (16.0, 29.4)
Highest 191 20.6 (14.3, 28.7) 183 56.2 (46.7, 65.2) 183 18.8 (12.4, 27.5)
Household food security
Secure 794 25.3 (21.4, 29.7) 0.5294 749 55.5 (50.7, 60.2) 0.7708 748 23.2 (19.3, 27.6) 0.3960
Mildly insecure 127 20.6 (12.8, 31.4) 125 51.9 (36.7, 66.6) 124 18.2 (11, 28.8)

131
REPORT- OCTOBER 2022
 Moderately insecure 216 26 (19.8, 33.2) 214 57.3 (48.9, 65.3) 212 23.4 (17.6, 30.4)

132
Severely insecure 62 33.4 (19.9, 50.2) 57 62.7 (45.4, 77.3) 57 33.4 (19.2, 51.4)
Educational level
Basic secondary or less 259 25.4 (19.3, 32.7) 0.874 253 56.7 (47.1, 65.7) 0.753 253 23.7 (17.8, 30.9) 0.747
Complete secondary or more 893 24.8 (21.6, 28.4) 849 55.0 (50.6, 59.4) 845 22.5 (19.2, 26.3)
Marital Status
Currently not married 394 23.9 (18.8, 29.8) 0.504 381 53.9 (46.7, 60.9) 0.440 380 22.1 (17.0, 28.1) 0.638
Currently married 809 26.0 (22.6, 29.8) 768 56.9 (52.5, 61.1) 765 23.6 (20.2, 27.4)
Currently lactating
Yes 212 20.0 (14.5, 26.9) 0.061 199 51.8 (42.8, 60.7) 0.425 198 18.1 (12.5, 25.5) 0.108
No 615 27.3 (23.3, 31.8) 589 56.4 (50.7, 61.9) 586 24.8 (20.7, 29.5)
TOTAL 1203 25.3 (22.3, 28.6) 1149 55.9 (51.8, 59.9) 1145 23.1 (20.1, 26.5)
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Note: The N’s are the denominators for a specific sub-group. For iron deficiency and iron deficiency anemia, the numbers are smaller than for anemia due to unsuccessful blood collection (sufficient
blood could be obtained only for the on-site analysis of hemoglobin concentration).
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Anemia defined as hemoglobin < 120g/L; hemoglobin adjusted for altitude.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Iron deficiency defined as inflammation adjusted plasma ferritin < 15 µg/L.
f
Iron deficiency anaemia defined as plasma ferritin < 15.0 μg/L and hemoglobin < 120g/ L.
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
 REPORT- OCTOBER 2022

3.7.6. Vit A deficiency

About 4% of non-pregnant women are vitamin A deficient, denoting a public health problem with mild
significance according to WHO. Only household food security status was significantly associated with vitamin
A deficiency, with a higher vitamin A deficiency prevalence found among women residing in severely food
insecure households (see Table 72).

Table 72. Prevalence of vitamin A deficiency in non-pregnant women 15-49 years of age, by various
demographic characteristics, the Kyrgyz Republic 2021

Characteristic N %a with VADb (95% CI)c p-valued

Age Group (in years)
15-19 273 6.1 (3.2, 11.5) 0.451
20-29 251 3.0 (1.5, 6.0)
30-39 356 4.2 (2.5, 6.8)
40-49 269 4.0 (2.2, 7.4)
Residence
Urban 454 4.3 (2.4, 7.8) 0.961
Rural 695 4.3 (3.0, 6.0)
Region
Batken oblast 132 7.9 (3.8, 15.6) 0.284
Jalal-Abad oblast 134 3.5 (1.5, 7.6)
Issyk-Kul oblast 121 7.3 (3.7, 14.2)
Naryn oblast 145 2.9 (0.9, 8.7)
Osh oblast 144 2.8 (1.2, 6.5)
Talas oblast 113 3.1 (1.2, 7.8)
Chui oblast 91 2.5 (0.8, 7.2)
Bishkek city 127 6.1 (2.5, 14.1)
Osh city 142 5.6 (2.8, 10.7)
Wealth quintile
Lowest 267 7.0 (4.1, 11.8) 0.280
Second 259 2.2 (0.9, 5.3)
Middle 219 4.1 (2.2, 7.4)
Fourth 217 3.6 (1.6, 7.8)
Highest 183 5.0 (1.9, 12.3)
Household food security
Secure 749 3.5 (2.3, 5.4) <0.05
Mildly insecure 125 4.4 (1.9, 9.8)
Moderately insecure 214 4.6 (2.1, 10.0)
Severely insecure 57 13.8 (5.5, 30.4)
Educational level
Basic secondary or less 253 6.6 (3.5, 11.8) 0.086
Complete secondary or more 849 3.5 (2.3, 5.1)
Marital Status
Currently not married 381 5.8 (3.5, 9.6) 0.115
Currently married 768 3.5 (2.4, 5.1)
Currently lactating
Yes 199 4.6 (3.3, 6.4) 0.228

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

No 589 2.9 (1.3, 6.0)

TOTAL 1149 4.3 (3.1, 5.9)
Note: The N’s are the denominators for a specific sub-group; for VAD, the numbers are smaller than for anemia due to unsuccessful
blood collection (only sufficient blood could be obtained for the on-site analysis of hemoglobin concentration) or insufficient sample
volumes for retinol binding protein analysis.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
VAD = Vitamin A deficiency, defined as RBP adjusted for inflammation [42] <0.569 umol/L.
c
CI=confidence interval calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

3.7.7. Folate deficiency

As shown in Table 73, and similar to adolescent girls, the prevalence of folate deficiency in non-pregnant
women aged 15-49 years is high in the Kyrgyz Republic. Folate deficiency significantly differs by household
wealth, with the largest proportion of women with folate deficiency living in households of the lowest and fourth
wealth quintile. Moreover, lactating women are more likely to be deficient in folate than those not lactating.
Other sub-group analyses did not yield significant correlations.

Table 73. Prevalence of folate deficiency in non-pregnant women 15-49 years of age by various demographic
characteristics, the Kyrgyz Republic 2021

Characteristic N % a with folate deficiencyb (95% CI)c p-valued

Age Group (in years)
15-19 273 85.7 (79.4, 90.3) 0.412
20-29 257 86.3 (80.3, 90.7)
30-39 359 81.1 (75.4, 85.8)
40-49 274 80.7 (72.3, 87.1)
Residence
Urban 459 82.1 (76.1, 86.8) 0.561
Rural 704 83.8 (80.5, 86.7)
Region
Batken oblast 137 82.5 (76.1, 87.4) 0.102
Jalal-Abad oblast 131 75.8 (69.2, 81.3)
Issyk-Kul oblast 121 90.3 (83.1, 94.6)
Naryn oblast 144 88.6 (79.3, 94.0)
Osh oblast 143 82.1 (74.6, 87.7)
Talas oblast 118 85.1 (79.5, 89.4)
Chui oblast 92 80.4 (67.6, 89.0)
Bishkek city 128 88.9 (80.7, 93.9)
Osh city 149 84.7 (78.6, 89.4)
Wealth quintile
Lowest 270 87.2 (81.2, 91.5) <0.05
Second 258 83.9 (76.7, 89.2)
Middle 222 74.6 (66.8, 81.2)
Fourth 224 87.2 (81.0, 91.6)
Highest 185 83.3 (75.1, 89.1)
Household food security
Secure 760 81.8 (78.9, 84.3) 0.329
Mildly insecure 124 80.5 (61.4, 91.5)

134
 REPORT- OCTOBER 2022

Moderately insecure 215 86.6 (79.8, 91.4)

Severely insecure 60 93.6 (83.6, 97.6)
Educational level
Basic secondary or less 252 83.1 (73.9, 89.5) 0.935
Complete secondary or more 865 83.4 (80.0, 86.3)
Marital Status
Currently not married 382 82.8 (76.1, 87.9) 0.859
Currently married 781 83.4 (80.1, 86.3)
Currently lactating
Yes 204 89.0 (83.4, 92.9) <0.05
No 597 81.0 (76.9, 84.6)
TOTAL 1163 83.2 (80.3, 85.8)
Note: The N’s are the denominators for a specific sub-group; for folate, the numbers are smaller than for anemia due to unsuccessful
blood collection (sufficient blood could only be obtained for the on-site analysis of hemoglobin concentration) or insufficient sample
volumes for folate analysis.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Folate deficiency defined as plasma folate <10 nmol/L.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

3.7.8. Vitamin D deficiency

Although no significant differences were found between any of the investigated indicators and vitamin D deficiency,
data indicates that the prevalence is lower in young women compared to older women (see Table 74).

Table 74. Prevalence of vitamin D deficiency in non-pregnant women 15-49 years of age, by various
demographic characteristics, the Kyrgyz Republic 2021

Deficienta Insufficienta Deficient or insufficient

Characteristic
N b
% c
(95% CI) d
% c
(95% CI) d
%c (95% CI)d p-valuee
Age Group (in years)
15-19 76 15.7 (8.7, 26.6) 21.7 (13.9, 32.2) 37.4 (27.1, 49.0) 0.070
20-29 67 15.9 (7.8, 29.7) 46.3 (34.0, 59.0) 62.2 (48.4, 74.2)
30-39 107 14.6 (8.7, 23.4) 36.2 (26.6, 46.9) 50.7 (39.7, 61.7)
40-49 65 17.3 (9.6, 29.0) 38.0 (25.2, 52.6) 55.2 (40.6, 69.0)
Residence
Urban 131 19.9 (14.9, 26.1) 37.0 (29.1, 45.7) 57.0 (47.4, 66.1) 0.148
Rural 184 13.0 (8.1, 20.3) 34.5 (28.5, 41.2) 47.6 (39.2, 56.1)
Wealth quintile
Lowest 71 9.0 (3.6, 20.8) 33.8 (23.3, 46.2) 42.8 (31.4, 55.1) 0.688
Second 63 20.7 (11.8, 33.7) 29.4 (18.8, 42.7) 50.1 (36.1, 64.0)
Middle 64 20.1 (10.1, 36.1) 34.6 (23.1, 48.2) 54.7 (40.4, 68.3)
Fourth 63 13.8 (6.4, 27.4) 35.9 (24.8, 48.7) 49.7 (35.5, 64.0)
Highest 52 14.3 (7.9, 24.7) 42.1 (29.6, 55.6) 56.4 (42.1, 69.7)
Household food security
Secure 194 15.6 (10.9, 21.8) 38.9 (32.2, 46.0) 54.4 (45.7, 63.0) 0.505
Mildly insecure 36 6.1 (1.4, 22.7) 41.9 (26.0, 59.8) 48.0 (30.8, 65.7)

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Moderately inse-
66 20.1 (10.3, 35.6) 22.9 (14.6, 33.9) 43.0 (30.8, 56.1)
cure
Severely insecure 17 20.3 (6.2, 49.4) 26.4 (10.4, 52.5) 46.7 (23.0, 71.9)
Educational level
Basic secondary
72 17.9 (11.1, 27.6) 25.5 (17.0, 36.5) 43.4 (33.0, 54.4) 0.198
or less
Complete sec-
231 14.6 (9.9, 20.8) 38.0 (31.6, 44.8) 52.5 (44.7, 60.2)
ondary or more
Marital Status
Currently not
106 20.0 (13.3, 28.8) 28.5 (20.8, 37.8) 48.5 (39.5, 57.6) 0.485
married
Currently married 209 13.4 (8.9, 19.7) 38.9 (32.2, 46.1) 52.4 (44.6, 60.0)
Currently lactating
Yes 65 10.9 (4.6, 23.6) 46.7 (33.7, 60.2) 57.6 (43.3, 70.8) 0.512
No 151 15.5 (10.3, 22.7) 36.7 (29.0, 45.0) 52.2 (43.0, 61.2)
TOTAL 315 15.6 (11.7, 20.4) 35.5 (30.5, 40.7) 51.1 (44.6, 57.5)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data
a
Deficient <12 ng/mL (<30nmol/L); Insufficient 12-19.9 ng/mL (30nmol/L-<50nmol/L). Vitamin D concentrations below the limit of
detection (<9 ng/mL; n=34) were recoded to 9 ng/mL.
b
25% sub-sample.
c
Percentages weighted for unequal probability of selection.
d
CI=confidence interval, calculated taking into account the complex sampling design.
e
Chi-square p-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

3.7.9. Iodine deficiency

Table 75 presents the iodine status of non-pregnant non-lactating women 15-49 years of age. Nationally,
the national mUIC is approximately 167 µg/L, indicating that non-pregnant women in the Kyrgyz Republic
have sufficient iodine status. Significant differences were observed by age group, region, and education level.
Despite these differences, all sub-groups indicated an adequate iodine status (i.e., mUIC 100-299 µg/L).

Table 75. Median urinary iodine concentration in non-pregnant non-lactating women 15-49 years of age, the
Kyrgyz Republic 2021

Characteristic N Median UICa (95% CI)b p-valuec

Age Group (in years)
15-19 252 186.19 (168.80, 202.24) <0.05
20-29 127 160.82 (143.83, 185.28)
30-39 277 157.69 (149.39, 175.29)
40-49 262 164.68 (136.03, 172.41)
Residence
Urban 343 164.34 (147.84, 165.13) 0.829
Rural 575 169.84 (165.20, 184.73)
Region
Batken oblast 114 199.67 (168.05, 216.82) <0.001
Jalal-Abad oblast 91 167.19 (168.05, 216.83)
Issyk-Kul oblast 104 195.85 (153.40, 193.70)
Naryn oblast 129 160.82 (171.21, 223.17)
Osh oblast 106 156.61 (129.27, 192.37)

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Talas oblast 93 202.04 (132.03, 180.58)

Chui oblast 75 166.10 (155.22, 262.94)
Bishkek city 103 154.08 (123.64, 168.11)
Osh city 103 151.71 (139.94, 168.24)
Wealth quintile
Lowest 228 157.94 (155.85, 186.79) 0.684
Second 208 175.17 (157.16, 190.98)
Middle 162 159.29 (136.94, 181.31)
Fourth 179 169.84 (145.67, 174.62)
Highest 138 174.81 (142.21, 188.39)
Educational level
Basic secondary or less 234 186.19 (170.39, 204.23) <0.001
Complete secondary or more 645 159.98 (151.76, 169.02)
Household food security
Secure 604 162.91 (154.51, 174.34) 0.291
Mildly insecure 97 173.35 (148.04, 181.72)
Moderately insecure 165 184.16 (157.6, 199.78)
Severely insecure 49 152.17 (125.1, 179.24)
Household salt iodization
None (<5 ppm) 11 147.81 (97.12, 187.95) 0.367
Insufficient (5-14.9 ppm) 234 162.39 (151.68, 176.93)
Adequate (15+ ppm) 630 175.07 (162.57, 184.15)
Household sanitation d

Unadequate 128 160.38 (151.45, 174.45) 0.741

Adequate 783 169.85 (159.59, 179.07)
Safe drinking water
Yes 903 166.60 (158.82, 174.32) 0.192
No 12 201.34 (95.6, 298.84)
TOTAL 918 167.19 (158.26, 174.9)
Note: The N’s are un-weighted denominators in each subgroup; the sum of subgroups may not equal the total because of missing data
a
Medians are weighted for unequal selection probability; UIC = urinary iodine concentration.
b
CI=confidence interval calculated by bootstrapping without taking into account the complex sampling design. Actual confidence inter-
vals probably narrower.
c
Chi-square p-value <0.05 indicates that the mean of the natural log of urinary iodine concentration in at least one subgroup is statis-
tically significantly different from the values in the other subgroups.
d
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
e
Composite variable of main source of drinking water and treating water to make safe for drinking.

Figure 28 presents the geographic distribution of mUIC by region, and shows that mUIC in all regions is
adequate — ranging between 100 and 299 µg/L; only Talas has a mUIC>200.

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Bishkek city

Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city Median urinary iodine

concentration (μg/L)
Osh oblast 0 - 49
50 - 99
Batken oblast
100 - 199
200 - 299
≥300

Figure 28. Geographic distribution of median urinary iodine concentration in non-pregnant non-lactating
women 15-49 years of age, the Kyrgyz Republic 2021

Table 76 presents the iodine status of non-pregnant lactating women. The national median urinary iodine
concentration (mUIC) is approximately 134 µg/L indicating an adequate iodine status. No significant differences
were observed between any of the sub-groups, which might be owed to the relatively small number of non-
pregnant lactating women. However, sub-group analyses indicate that iodine status of certain sub-groups
might be insufficient. Those are women living in severely food insecure households and women who live in
households using salt that was not iodized. Of note, numbers in the sub-group analyses are small and results
will have to be interpreted with caution.

Table 76. Median urinary iodine concentration in non-pregnant lactating women 15-49 years of age, the
Kyrgyz Republic 2021

Characteristic N Median UICa (95% CI)b p-valuec

Age Group (in years)
15-19 6 128.09 (38.03, 218.78) 0.251
20-29 113 124.35 (115.66, 140.49)
30-39 75 149.60 (131.12, 166.99)
40-49 5 195.38 (124.75, 266.00)
Residence
Urban 81 142.74 (115.69, 164.44) 0.875
Rural 118 130.51 (119.47, 145.04)
Region
Batken oblast 22 103.28 (95.64, 171.82) 0.449
Jalal-Abad oblast 33 128.01 (105.26, 150.91)
Issyk-Kul oblast 18 128.07 (33.15, 228.96)
Naryn oblast 17 150.29 (106.70, 200.26)
Osh oblast 36 133.58 (104.00, 160.10)
Talas oblast 12 237.3. (72.50, 274.44)
Chui oblast 15 179.85 (56.83, 233.47)
Bishkek city 11 124.35 (45.42, 203.27)
Osh city 35 140.07 (100.26, 174.64)

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Wealth quintile
Lowest 34 115.74 (91.30, 162.70) 0.970
Second 46 134.26 (124.83, 157.80)
Middle 52 134.46 (109.56, 152,98)
Fourth 38 125.96 (104.22, 161.38)
Highest 28 156.08 (91.17, 186.35)
Educational level
Basic secondary or less 6 108.96 (30.89, 182.34) 0.800
Complete secondary or more 191 134.46 (127.12, 147.77)
Household food security
Secure 127 120.01 (120.86, 140.16) 0.086
Mildly insecure 23 188.60 (141.80, 221.91)
Moderately insecure 39 151.19 (101.63, 200.75)
Severely insecure 9 85.33 (27.45, 190.46)
Household salt iodization
None (<5 ppm) 2 48.99 (0, 336.84) 0.547
Insufficient (5-14.9 ppm) 54 126.88 (111.01, 151.48)
Adequate (15+ ppm) 140 137.26 (124.58, 150.75)
Household sanitation d

Unadequate 31 128.09 (91.00, 165.18) 0.186

Adequate 167 134.88 (126.09, 148.81)
Safe drinking watere
Yes 192 134.04 (123.74, 144.98) 0.246
No 6 246.45
TOTAL 199 134.26 (124.03, 145.74)
Note: The N’s are un-weighted denominators in each subgroup; the sum of subgroups may not equal the total
because of missing data.
a
Medians are weighted for unequal selection probability; UIC = urinary iodine concentration.
b
CI=confidence interval calculated by bootstrapping without taking into account the complex sampling design. Actual confidence inter-
vals probably narrower.
c
Chi-square p-value <0.05 indicates that the mean of the natural log of urinary iodine concentration in at least one subgroup is statisti-
cally significantly different from the values in the other subgroups.
d
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour
flush toilet or pit latrine with slab not shared with another household. Inadequate sanitation = open pit, bucket latrine, hanging toilet/
latrine, no facility, bush, field
e
Composite variable of main source of drinking water and treating water to make safe for drinking.

Figure 28 presents the geographic distribution of mUIC by region, and shows that mUIC in all regions is
adequate — ranging between 100 and 299 µg/L; only Talas has a mUIC>200.

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Bishkek city
Chui oblast
Talas oblast

Issyk-Kul oblast

Jalal-Abad oblast
Naryn oblast

Osh city Median urinary iodine

concentration (μg/L)
Osh oblast 0 - 49
50 - 99
Batken oblast
100 - 199
200 - 299
≥300
Figure 29. Geographic distribution of median urinary iodine concentration in non-pregnant lactating women
15-49 years of age, the Kyrgyz Republic 2021

3.7.10. Associations between micronutrient deficiencies and various factors

Iron, as well as vitamin A deficiency are highly significantly associated with anemia in women 15-49 years of
age, as can be seen in Table 77. Moreover, women living in households without access to safe drinking water
have a significantly higher prevalence of anemia. Moreover, although the difference is not significant, the data
indicates that women drinking coffee or tea during or directly after their meals have a higher prevalence of
anemia compared to those who don’t. Anemia is not associated with the intake of mineral and vitamins in the
past 6 months prior to the survey, which is not surprising since only very few women still took supplements at
the time of the survey.

Table 77. Correlation between various factors and anemia in non-pregnant women 15-49 years of age, the
Kyrgyz Republic 2021

Characteristic N %a Anemic p valueb

Woman’s household had adequate sanitation
Yes 1011 25.3 0.888
No 184 24.7
Woman’s household had safe drinking water
Yes 1178 24.7 <0.001
No 21 52.7
Minimum dietary diversity
Yes 837 24.3 0.347
No 366 27.5
Took iron tablets or syrup in past 6 months
Yes 129 28.6 0.389
No 1067 24.8
Took folate supplements in past 6 months
Yes 96 21.7 0.472
No 1099 25.6

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Took vitamin A tablets in past 6 months

Yes 78 27.9 0.723
No 1115 25.2
Took multivitamin supplements in past 6 months
Yes 138 26.0 0.896
No 1054 25.4
Took vitamin D supplements in past 6 months
Yes 90 28.9 0.518
No 1102 25.2
Consumes coffee or tea during or directly after meal
Yes 1036 26.7 0.057
No 167 18.0
Household flour iron fortificationc
None 386 26.5 0.971
НеAdequate 125 25.2
Adequately fortified 8 26.9
Woman had inflammation
Yes 185 24.3 0.821
No 960 25.3
Woman iron deficient
Yes 650 41.4 <0.001
No 495 4.5
Woman vitamin A deficient
Yes 55 53.9 <0.001
No 1090 23.8
Woman folate deficient
Yes 981 25.9 0.237
No 183 21.4
Woman vitamin D status d

Normal 130 30.0 0.578

Insufficient 126 24.9
Deficient 60 22.9
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P value <0.05 indicates that the groups are statistically significantly different from each other.
c
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fuma-
rate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm.
d
Vitamin D deficiency measured in a 25% sub-sample of women.

The prevalence of ID was significantly higher in women without access to safe drinking water, as shown in
Table 78. Moreover, women drinking coffee or tea during or directly after their meals have a higher prevalence
of ID compared to those who don’t. Further, the prevalence of ID is higher in folate deficient women compared
to those with normal folate status. Though the difference is not significant, data suggests that women with
vitamin A deficiency are more likely to be iron depleted than those without. The intake of supplements is not
associated with ID, possibly since very few women consumed supplements at the time of the survey.

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Table 78. Correlation between various factors and iron deficiency in non-pregnant women 15-49 years of age,
the Kyrgyz Republic 2021

Characteristic N %a Iron deficiency p valueb

Woman’s household had adequate sanitation
Yes 964 55.6 0.855
No 177 56.6
Woman’s household had safe drinking water
Yes 1125 55.3 <0.05
No 20 76.0
Minimum dietary diversity
Yes 798 54.0 0.129
No 351 60.2
Took iron tablet or syrup in past 6 months
Yes 123 56.9 0.831
No 1020 55.6
Took folate supplements in past 6 months
Yes 88 52.2 0.587
No 1053 56.1
Took multivitamin supplements in past 6 months
Yes 132 62.2 0.241
No 1006 54.8
Consumes coffee or tea during or directly after meal
Yes 988 57.8 <0.05
No 161 45.5
Household flour iron fortification c

None 376 54.2 0.340

НеAdequate 119 48.6
Adequately fortified 7 72.1
Woman had inflammation
Yes 185 47.4 0.054
No 964 57.4
Woman vitamin A deficient
Yes 55 71.5 0.079
No 1090 55.2
Woman folate deficient
Yes 961 58.6 <0.05
No 177 45.6
Woman vitamin D statusd
Normal 126 61.6 0.454
Insufficient 123 53.6
Deficient 60 53.2
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P value <0.05 indicates that the groups are statistically significantly different from each other.
c Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fuma-
rate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm.
d
Vitamin D deficiency measured in a 25% sub-sample of women.

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As shown in Table 79, women with elevated inflammation markers are more likely to be vitamin A deficient
than those who do not have elevated markers. None of the other investigated factors is associated with
vitamin A status.

Table 79. Correlation between various factors and vitamin A deficiency in non-pregnant women 15-49 years of
age, the Kyrgyz Republic 2021

Characteristic N %a Vit A deficiency p valueb

Woman’s household had adequate sanitation
Yes 964 4.3 0.922
No 177 4.1
Woman’s household had safe drinking water
Yes 1125 4.3 0.748
No 20 3.3
Minimum dietary diversity
Yes 798 4.7 0.349
No 351 3.4
Took iron tablet or syrup in past 6 months
Yes 123 2.2 0.190
No 1020 4.6
Took vitamin A tablets in past 6 months
Yes 76 3.3 0.693
No 1063 4.4
Took multivitamin supplements in past 6 months
Yes 132 2.3 0.227
No 1006 4.6
Woman had inflammation
Yes 185 9.8 <0.005
No 964 3.3
Woman folate deficient
Yes 961 3.9 0.208
No 177 6.5
Woman vitamin D status c

Normal 126 5.8 0.427

Insufficient 123 3.1
Deficient 60 7.6
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P value <0.05 indicates that the groups are statistically significantly different from each other.
c
Vitamin D deficiency measured in a 25% sub-sample of women.

Although the prevalence of folate deficiency is higher in women who did not consume folic acid supplements in
the past 6 months prior to the survey, this difference is not significant. Of the women that reported consuming
folic acid in the past 6 months, only those women who were consuming folic acid supplements during the
survey had a significantly lower prevalence of folate deficiency than those that had taken folic acid previously.
None of the other investigated factors is significantly correlated with folate deficiency in women.

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Table 80. Correlation between various factors and folate deficiency in non-pregnant women 15-49 years of age,
the Kyrgyz Republic 2021

Characteristic N %a Folate deficiency p valueb

Woman’s household had adequate sanitation
Yes 979 83.3 0.734
No 176 81.9
Took iron tablet or syrup in past 6 months
Yes 126 79.4 0.315
No 1030 83.7
Took folate supplements in past 6 months
Yes 93 78.4 0.270
No 1062 83.6
Currently taking folate supplements
Yes 28 49.3 <0.001
No 65 90.2
Took multivitamin supplements in past 6 months
Yes 135 83.6 0.917
No 1017 83.2
Household flour iron fortificationc
None 377 86.2 0.833
Insufficient 122 84.7
Adequate 7 91.1
Woman had inflammation
Yes 182 79.1 0.193
No 956 84.0
Woman vitamin D status d

Normal 129 81.3 0.293

Insufficient 125 84.9
Deficient 60 92.6
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P value <0.05 indicates that the groups are statistically significantly different from each other.
c
Folate part of the fortification premix, flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA
5-<15ppm; ferrous sulfate, ferrous fumarate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate
≥60ppm.
d
Vitamin D deficiency measured in a 25% sub-sample of women.

Although the prevalence of vitamin D deficiency is 20 percentage point higher in women who did not take vitamin
D supplements compared to those taking supplements in the 6 months prior to the survey, this difference is not
significant, most likely due to the small number of observations. None of the other indicators was significantly
associated with vitamin D deficiency.

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Table 81. Correlation between various factors and vitamin D deficiency in non-pregnant women 15-49 years
of age, the Kyrgyz Republic 2021

%a Vitamin D deficient or
Characteristic N p valueb
insufficient
Woman’s household had adequate sanitation
Yes 271 52.4 0.101
No 41 39.6
Woman’s household had safe drinking water
Yes 309 51.1 0.354
No 4 26.2
Minimum dietary diversity
Yes 215 52.3 0.591
No 100 48.4
Took multivitamin supplements in past 6 months
Yes 41 49.0 0.717
No 271 52.2
Took vitamin D supplements in past 6 months
Yes 21 34.3 0.113
No 291 53.2
Woman had inflammation
Yes 51 49.3 0.735
No 258 52.2
Note: The N’s are the denominators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
Chi-square test; P value <0.05 indicates that the groups are statistically significantly different from each other.

3.8. Pregnant women

3.8.1. Characteristics

As shown in Table 82 below, the NIMAS recruited 176 pregnant women, approximately 60% of which resided
in rural areas. About 40% were in the third trimester of the pregnancy, and almost nine out of ten pregnant
women had completed at least secondary school. The majority of pregnant women enrolled in the NIMAS was
between 20-39 years of age, and as there were only a few pregnant women <20 and ≥40 years of age, only two
age sub groups have been used for bivariate analyses presented below (i.e., 18-29 years, 30-45 years).

Table 82. Description of pregnant women, the Kyrgyz Republic 2021

Characteristic N %a
Age (in years)
18-19 8 5.3
20-29 92 49.8
30-39 70 41.1
40-45 6 3.8
Urban/rural
Urban 82 40.1
Rural 94 59.9

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Region
Batken oblast 19 7.4
Jalal-Abad oblast 20 16.8
Issyk-Kul oblast 17 7.3
Naryn oblast 12 3.3
Osh oblast 21 17.1
Talas oblast 17 4.5
Chui oblast 21 20.6
Bishkek city 22 16.8
Osh city 27 6.3
Wealth quintile
Lowest 30 15.2
Second 37 24.0
Middle 38 24.2
Fourth 42 21.8
Highest 28 14.7
Educational level
Basic secondary or less 18 13.5
Complete secondary or more 158 86.5
Trimester of pregnancy
1 54 32.8
2 47 27.2
3 70 40.1
TOTAL 176 100.0
Note: The N’s are un-weighted numbers in each subgroup. Subgroups that do not sum to the total have missing data.
a
Percentages weighted for unequal probability of selection among regions.

3.8.2. Dietary diversity and consumption of vitamins and mineral supplements

As shown in Table 83, pregnant women consumed, on average, more than 6 food groups in the 24 hours prior
to the interview. Almost 70% of pregnant women met the minimum dietary diversity and ate ≥ 5 food groups
during this time period. Only one-third consumed iron tables in the past 6 months, and just over half of the
pregnant women took folic acid supplements. .

Table 83. Dietary diversity and consumption of vitamin and mineral supplement in pregnant women, the
Kyrgyz Republic 2021

Characteristic N %a or mean (95% CI)b

Number of food groups consumed (mean) 173 6.4 (6.0, 6.7)
Meet minimum dietary diversity (5+ food groups)
Yes 120 66.5 (57.6, 74.4)
No 53 33.5 (25.6, 42.4)
Took iron tablets or syrup in past 6 months
Yes 70 37.9 (30.2, 46.2)
No 101 61.0 (52.5, 68.9)
Don’t know 2 1.1 (0.2, 5.5)

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Consumed folic tablets in past six months

Yes 97 56.2 (47.3, 64.7)
No 74 42.7 (34.2, 51.6)
Don’t know 2 1.1 (0.2, 5.4)
Took multivitamin supplements in past 6 months
Yes 47 24.1 (18.2, 31.1)
No 125 75.7 (68.6, 81.5)
Don’t know 1 0.2 (0, 1.7)
Note: The N’s are the numerators for a specific sub-group.
a
Percentages weighted for unequal probability of selection among regions.
b
CI=confidence interval, calculated taking into account the complex sampling design.

3.8.3. Mid-upper arm circumference

Mid-upper arm circumference (MUAC) measurements were successfully collected for 133 pregnant women.
Mean MUAC was 26.9 cm (95%CI: 26.0, 27.8), and the unweighted standard deviation was 3.94 cm. The
percentage of pregnant women considered underweight (i.e., MUAC <23 cm) was 6.9% (95%CI: 3.1, 14.5). Due
to the small sample size of pregnant women, no sub-group analysis could be conducted.

3.8.4. Anemia

Approximately 49% of pregnant women in the Kyrgyz Republic are anemic, with significant differences by
pregnancy trimester (see Table 84). Anemia during the first and second trimesters were similar, and denoted a
moderate public health problem, whereas anemia in the third trimester is classified as a severe public health
problem and affects more than 70% of women. As shown in Figure 30, severe anemia was rare (1.4%; 95% CI:
0.3, 6.9; n=2), with most anemia cases classified as moderate (27.8%; 95% CI: 20.0, 37.2; n=32) or mild (19.8%;
95% CI: 14.1, 27.1; n=30).

Table 83. Prevalence of anemia in pregnant women, by various demographic characteristics, the Kyrgyz
Republic 2021

Characteristic n %a, b (95% CI)c p-valued

Age (in years)
18-29 80 44.4 (31.0, 58.6) 0.354
30-45 60 54.5 (40.5, 67.9)
Urban/rural
Urban 59 51.5 (36.6, 66.2) 0.681
Rural 81 47.5 (36.2, 59.2)
Wealth quintile
Lowest 26 53.5 (32.1, 73.7) 0.970
Second 29 51.1 (29.3, 72.5)
Middle 30 45.6 (27.3, 65.2)
Fourth 36 45.3 (30.0, 61.7)
Highest 18 45.5 (24.4, 68.4)
Educational level
Basic secondary or less 12 56.7 (26.4, 82.7) 0.598
Complete secondary or more 128 47.9 (38.6, 57.4)

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Trimester of pregnancy
1 40 31.5 (17.9, 49.1) <0.01
2 38 36.5 (19.3, 57.9)
3 58 71.8 (55.5, 83.9)
Household flour iron fortification c

None 19 49.0 (23.0, 75.5) 0.661

Insufficient 8 53.8 (17.4, 86.5)
Adequate 1 100.0 -
TOTAL 142 49.3 (39.8, 58.2)
Note: The N’s are the denominators for a specific sub-group. Sub-group Ns that do not sum to the total occur because of a) missing data,
or b) when a small number of pregnant women had to be excluded from the sub-group analysis as they were the only pregnant women
residing in their particular strata, which prevented the correct weighting of the survey results.
a
Anemia defined as hemoglobin < 110 g/L adjusted for altitude.
b
Percentages weighted for unequal probability of selection among regions.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
Flour sample collected in a 25% sub-sample of households, inadequately fortified: iron EDTA 5-<15ppm; ferrous sulfate, ferrous fuma-
rate 5-<60ppm; adequately fortified: iron EDTA ≥15ppm; ferrous sulfate, ferrous fumarate ≥60ppm.

20
Percent of pregnant worn en

15

10

0
40 60 80 100 120 140 160
Hemoglobin concentration (g/L)

Median: 109.9 g/L Survey sample

Figure 30. Distribution of hemoglobin (g/L) in pregnant women, the Kyrgyz Republic 2021

3.8.5. Iodine deficiency

The mUIC for pregnant women is presented in Table 85. As a mUIC between 150-249 µg/L is considered
adequate for pregnant women, only pregnant women residing in households in the highest wealth quintile
would be classified with inadequate iodine status. All other sub-groups would be considered adequate. Of note,
pregnant women 18-19 years of age have an mUIC of approximately 249 µg/L, and were thus just below the
threshold for being classified with excess iodine intake (data not shown).

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Table 85. Median urinary iodine concentration in pregnant women, the Kyrgyz Republic 2021

Characteristic N Median UICa (95% CI)b

Age (in years)
18-29 62 195.17 (142.24, 209.61)
30-45 48 180.49 (121.55, 195.64)
Urban/rural
Urban 43 209.08 (120.20, 219.49)
Rural 67 180.49 (142.12, 207.32)
Wealth quintile
Lowest 18 213.66 (146.75, 315.80)
Second 26 188.46 (135.43, 229.13)
Middle 22 160.78 (84.24, 239.93)
Fourth 29 214.86 (114.79, 210.82)
Highest 14 125.13 (38.91, 200.36)
Educational level
Basic secondary or less 9 167.16 (101.14, 233.18)
Complete secondary or more 101 185.07 (146.00, 198.67)
Trimester of pregnancy
1 32 180.49 (132.90, 207.04)
2 31 174.72 (100.47, 226.30)
3 43 219.44 (149.78, 260.01)
Household salt iodization
None (<5 ppm) 0 - -
Insufficient (5-14.9 ppm) 37 177.13 (111.76, 195.91)
Adequate (15+ ppm) 72 180.49 (143.14, 207.68)
TOTAL 110 180.49 (146.28, 198.36)
Note: The N’s are un-weighted denominators in each subgroup; the sum of subgroups may not equal the total because of missing data.
a
Medians are weighted for unequal selection probability; UIC = urinary iodine concentration.
b
CI=confidence interval calculated by bootstrapping without taking into account the complex sampling design. Actual confidence inter-
vals probably narrower. No p-values could be estimated because of the small number of subjects within each sub-group.

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OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

4. DISCUSSION AND CONCLUSIONS

4.1. Household level findings

Almost all households in the Kyrgyz Republic use safe water for drinking and have access to adequate sanitation
facilities, and about four out of five households use clean fuel for cooking. These results are consistent with
the MICS 2018 [11].

Household level data show that food security is a notable problem in the Kyrgyz Republic, particularly in Issyk
Kul, Naryn, and Chui, where just about half of the households report to be food insecure and about every tenth
household is severely food insecure. Food insecurity in the Kyrgyz Republic is mainly driven by poverty, which is
reflected in the NIMAS data as a large proportion of severely food insecure households are in the lowest wealth
quintile. Moreover, household food insecurity is significantly associated with numerous nutrition indicators
across multiple population groups, such as wasting and iron deficiency anemia among children 6-59 months
of age, thinness, anemia and iron deficiency among children 5-9 years of age, and vitamin A deficiency in non-
pregnant women. In addition, food security status is associated with minimum dietary diversity in children 6-23
months of age, children 5-9 years of age, adolescent girls and non-pregnant women, suggesting that poor
household food security limits individual diets.

While in 2020, more than 25% of the Kyrgyz Republic’s population lived below the poverty line, the situation
worsened in 2021, mainly due to the global food crises and the COVID 19 pandemic and poverty increased to
33% [7]. Almost half of the households included in the NIMAS reported that COVID had a negative impact on
the income and about 90% stated that prices for food have increased since the outbreak of the pandemic, only
about every seventh household received assistance.

Salt was sampled from almost all households and analyzed qualitatively using rapid test kits and quantitatively
using the iReader device. Qualitative analyses showed that about 99% of the salt is iodized, which is slightly
higher than estimated in 2018 [11] and in agreement with the respondents perception of the salt iodization
status. According to WHO, salt should contain 15-45mg iodine/kg to prevent iodine deficiency disorders [58].
Using the iReader we found that about 98% of households use iodized salt (concentration ≥ 5ppm), 75%
use adequately iodized salt (≥ 15 ppm) and about 13% of the salt used by the households was found to be
inadequately iodized. Excess iodization in the Kyrgyz Republic is rare, with less than 4% of the salt having an
iodine concentration >45ppm, the vast majority below 55ppm. However, using the cut-off set by the Kyrgyz
government (40±15mg iodine/kg salt), only about 31% of the salt can be classified as adequately iodized.
According to WHO, an iodization program should reach a coverage of >90% of households with adequately
iodized salt [58] to be considered “universal”. This threshold was only met in Bishkek, where about 95% of the
households used adequately iodized salt using the WHO cut-off of ≥ 15 ppm. Significant differences in iodine
salt concentration also exist between the different salt brands, and only two salt brands, “Extra” and “Extra
Povarenok”, were found to have approximately 90% of samples adequately iodized. Nevertheless, particularly
when taking into consideration the iodine status of adolescent girls and women, the iodine fortification program
in the Kyrgyz Republic is functioning well.

The Law of the Kyrgyz Republic “on fortification of baking flour”, which was amended in 2015, decreed that
domestically-produced and imported premium and first grade flour should be fortified. Specifically, every
entrepreneur active in the field of production, transportation, storage and sale of fortified flour is obliged to
guarantee its safety and quality in accordance with requirements of technical regulations or normative legal
acts and standards. Further, manufacturers or suppliers should carry out certification or declaration of fortified
flour on conformity. Almost all households had flour at home at the time of the NIMAS. More than half of the
households reported to use fortified flour (by perception), which is in accordance with the results of a flour
fortification monitoring report from 2017 [72]. About three-quarter of the households with flour had it in its
original package, and most of the packages stated that the flour was fortified. Nevertheless, only one quarter of
all samples collected were fortified and just about 2% adequately fortified. Moreover, no difference in fortification
status were found between flours that were labelled as fortified on the package and those that were not. Further,
no differences were observed between flour produced in the Kyrgyz Republic and imported flour.

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As wheat flour producers typically fortify with micronutrient premix, our results of the iron in the Kyrgyz
Republic’s wheat flour indicate that the levels of the other micronutrients mandated by the Kyrgyz Republic’s
fortification standards (i.e., vitamin B1, B2, B3, zinc, and folic acid) were also only present at adequate levels
in about 2% of samples.

4.2. Under- and overnutrition

The NIMAS identified 7% of children 6-59 months of age as being stunted, which is lower than the 11% of
children classified as stunted in the MICS 2018 [11]. Although classified as a mild public health problem at the
national level, stunting is considered a problem with medium public health significance for certain sub-groups,
such as children with low birth weight, children living in Batken, and children whose households are of the
lowest wealth quintile, severely food insecure, and children residing in households with no adequate sanitation
or no safe drinking water.

Wasting and underweight in children 6-59 months of age living in the Kyrgyz Republic is rare with a prevalence
of less than 1%, which is in alignment with the MICS 2018 [11].

The prevalence of overweight and obesity in children 6-59 months of age can be classified as a problem
with “medium” public health significance. A low prevalence in overweight and obesity in early childhood is
important to prevent or minimize upward trends and increased risk of overweight and obesity in older children
and adolescents [70]. Our data show that the prevalence of overweight and obesity steadily increases with
increasing age and affects about 20% of adolescent girls aged 15-18 years. Since overweight and obesity have
been associated with type 2 diabetes in children and adolescents [73,74], these conditions could become public
health problems in the Kyrgyz Republic in the near future if overweight and obesity prevalence continue to
increase. The NIMAS estimates that nearly 45% of non-pregnant women 15-49 years of age are overweight or
obese, which is an increase of 9 percentage points compared to 2018 [11]. The prevalence of overweight and
obesity clearly increases with age: More than 75% of women 45-49 years of age are either overweight or obese.
Obesity is often associated with low grade inflammation and the development of metabolic disorders such as
type 2 diabetes and certain cardiovascular diseases [75,76] and plays a central role in the development of the
metabolic syndrome [77]. As a result, the Kyrgyz Republic may expect a rise in the incidence of several chronic
diseases associated with overweight and obesity.

4.3. Anemia and iron deficiency

Both anemia and iron deficiency (ID) are common in women and children 6-59 months of age in the Kyrgyz
Republic. Anemia would be considered a “moderate” public health problem in non-pregnant women and
children 6-59 months of age and a severe public health problem in pregnant women according to the criteria
published by the World Health Organization[36]. Anemia is less common in children 5-9 years of age and
adolescent girls, posing a “mild” public health problem [36]. Compared to the micronutrient survey conducted
in 2009 — which measured hemoglobin using the HemoCue 301 —the prevalence in children 6-59 months of
age fell by five percentage points and increased by three percentage points in non-pregnant women. Our results
are therefore in alignment with the results from 2009 and could indicate that the much higher prevalence
observed in the DHS 2012 — which measured hemoglobin using the HemoCue 201+ device — is due to the use
of different HemoCue models used. Recent literature has assessed the potential bias introduced by using of
different pre-analytical techniques (e.g. capillary vs. venous samples) but also equipment-induced differences,
suggesting that there are systematically lower readings of the hemoglobin concentrations when the HemoCue
201+ was used compared to the HemoCue 301 or CBC analyzers [46,78]. On the other hand, there is also some
evidence that the HemoCue 301, which was used by the NIMAS, yields higher hemoglobin concentrations
compared to CBC analyzers [79]. Of note, the NIMAS used venous blood for all hemoglobin measurements in
children 6-59 months of age, children 5-9 years of age, and non-pregnant adolescent girls and women. The
use of venous blood prevented any bias in all population groups except pregnant women that could potentially
arise from capillary blood samples, which can have variable hemoglobin concentrations depending on the drop
(i.e., first, second, third, etc) that is taken [80]. In order to validate the HemoCue 301 results, hemoglobin was
measured in a sub-sample of the NIMAS survey population using a CBC analyzer. We found a good correlation
between the HemoCue and the CBC analyzer (see Appendix 8.7). The CBC analyzer yielded a 4g/L lower
mean hemoglobin concentration, indicating that the real prevalence of anemia is likely somewhat higher than
estimated, particularly since a large part of the population has hemoglobin concentration around the anemia

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cut-off. However, the results also confirm that the classification of the anemia public health relevance, which
is based on the HemoCue 301 results, is in agreement with both methods.

The prevalence of both anemia and iron deficiency in the Kyrgyz Republic is higher in poor, food insecure
households, particularly in rural areas and in certain regions such as Naryn and Issyk Kul. Regardless, the
NIMAS survey results show that the prevalence of anemia and iron deficiency is comparable to neighboring
countries with recent data [81].

Iron deficiency has been identified in this survey as a strong putative risk factor for anemia in all population
groups, and a large proportion of individuals with anemia have concurrent iron deficiency, ranging from 60% of
the anemic children 5-9 years of age to 95% of the anemic adolescent girls. This proportion of individuals with
concurrent anemia and iron deficiency is higher than estimated by meta-analyses, which calculated that about
half of the anemia is associated with iron deficiency in countries where anemia is a moderate public health
problem [82]. In children 6-59 months of age, the NIMAS found that iron deficiency was the only investigated
risk factor associated with anemia. For children 5-9 years of age, anemia was also found to be more prevalent
in those with elevated inflammation markers, indicating that anemia of inflammation and chronic disease also
contribute to the overall anemia burden, but most likely to a lower extent than anemia due to iron deficiency.

For women and adolescent girls, vitamin A deficiency was also found to be highly associated with anemia.
Vitamin A deficiency reduces hemoglobin concentration via multiple mechanisms, including increased
frequency and severity of infectious diseases and poor mobilization of iron stores from tissues. Moreover,
recent data indicates that vitamin A deficiency has direct effects on anemia, possibly independent of the
mechanisms listed above [83].

Anemia was significantly lower in adolescent girls who took folate supplements in the past six months prior
to the survey indicating that also megaloblastic anemia might contribute to the overall anemia prevalence.
Folate deficiency is not identified as a risk factor for anemia in the survey, which could be due to the fact that
the definition of folate deficiency the NIMAS used is the WHO-recommended serum folate concentration cutoff
of <10 nmol/L, which (according to the biomedical literature) is the folate concentration at which homocysteine
levels begin to increase[40]. Homocysteine concentrations start rising at a very early stage of folate deficiency,
thus a large part of those diagnosed with folate deficiency have no megaloblastic changes in the blood and
bone marrow. Second, anemia is multifactorial and almost all women and adolescent girls have concomitant
anemia and iron deficiency.

4.4. Vitamin A deficiency

Vitamin A deficiency is present in all population groups and poses a mild public health problem in adolescent
girls and non-pregnant women, and a moderate public health problem in children. Compared to the
micronutrient survey conducted in 2009, the vitamin A deficiency prevalence in children 6-59 months of age and
non-pregnant women increased by 11 and 4 percentage points, respectively. It is likely that the termination of
the vitamin A supplementation program in 2011 and the discontinuation of the “Gulazyk” micronutrient powder
program in 2018 led to the substantial increase in vitamin A deficiency prevalence from 2009 to 2021. While
vitamin A status poses a mild to moderate public health problem nationally, the problem can be classified as
severe in certain regions. Specifically, the problem is severe in children 6-59 months of age living in Bishkek
and in children 5-9 years of age living in Chui and Osh City. Moreover, vitamin A deficiency is highly associated
with elevated inflammation markers in children, adolescent girls and women, highlighting the important role
of vitamin A in immune health.

4.5. Folate deficiency

Folate deficiency is very high in Kyrgyz adolescent girls and non-pregnant women. As already mentioned
above, the NIMAS uses a serum folate concentration as threshold for folate deficiency at which homocysteine
levels start to rise; thus women in the very yearly stages of folate deficiency are classified as deficient. Using
the threshold for more severe folate deficiency at which megaloblastic changes tend to appear would have
resulted in a lower prevalence. This was, however, not possible since WHO only recommends a cut-off based
on megaloblastic changes using microbiologic assays and not protein-binding assays, which has been used
in this survey. The 2009 survey measured folate in red blood cells and found that almost 40% of non-pregnant

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women were deficient and 98% had insufficient folate status. The high prevalence of folate deficiency found
in the NIMAS merits attention, particularly since folate deficiency is the main cause of neural tubes defects
and increases the risk of preterm delivery, infant low birth weight, and fetal growth retardation. A recent
micronutrient survey conducted in Uzbekistan, using the same deficiency threshold, also reported a very high
prevalence of folate deficiency in non-pregnant women [84]. Though the prevalence in Uzbekistan was about
45% nationally, it was higher in certain regions and highest in those bordering the Kyrgyz Republic (almost
60%). The higher prevalence observed in the Kyrgyz Republic might be explained by the very low proportion
of adequately fortified flour and the small number of adolescent girls and non-pregnant women consuming
supplements containing folic acid.

4.6. Vitamin D deficiency

The prevalence of vitamin D deficiency in children 6-59 months of age is only 5% and increases to 9% and
15% in adolescent girls and non-pregnant women, respectively. Similarly, the proportion of individuals with
insufficient vitamin D status is lowest in young children and highest in non-pregnant women. Compared to
other countries with vitamin D deficiency prevalence data [85–87], the prevalence in the Kyrgyz Republic is
relatively low. Significant differences were detected in children 6-59 months of age with respect to vitamin D
deficiency or insufficiency prevalence: About half of the children 6-11 months of age and half of the children
living in the wealthiest households have suboptimal vitamin D status. The large proportion of young children
with suboptimal status could be related to the relatively large proportion of women with vitamin D deficiency or
insufficiency (about 50%) since foetal vitamin D status depends on maternal status. Though vitamin D deficiency
prevalence in the Kyrgyz Republic can be considered low, the high prevalence of children 6-59 months of
age with suboptimal status merits attention due to the important role of vitamin D in the processes of cell
proliferation, differentiation, and maturation.

4.7. Iodine deficiency

Nationally, the mUIC in adolescent girls, non-pregnant and pregnant women indicate an adequate iodine status
in all population groups. Though significant differences were observed for some sub-groups, only pregnant
women residing in households in the highest wealth quintile were identified with inadequate iodine status. Of
note, pregnant women 15-19 years of age and non-pregnant adolescent girls living in Talas have an mUIC just
below the threshold for being classified with excess iodine intake.

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5. STRENGTHS AND LIMITATIONS

The NIMAS yielded national and region-specific prevalence estimates for a variety of micronutrient and
nutrition biomarkers in children 6-59 months of age, children 5-9 years of age, adolescent girls 10-18 years
of age, non-pregnant women 15-49 years of age and pregnant women, which will guide future decisions of
national stakeholders and inform national nutrition programs.

The NIMAS yielded satisfactory response rates for households, children 5-9 years of age, adolescent girls
and non-pregnant women. However, a relatively high refusal rate for blood sampling among children 6-59
months of age and some technical difficulties to successfully collect venous blood samples in young children
were experienced, which resulted in a slightly smaller number of children with blood samples than initially
estimated. Hence, while the survey yielded national estimates with satisfactory precision for children 6-59
months of age, the reduced sample size led to slightly lower precision for stratum- and age-specific prevalence
estimates than initially calculated.

Although previous surveys have measured the coverage of iodized salt qualitatively, the NIMAS measured
household salt samples both qualitatively and quantitatively, which yielded a more accurate estimation of
household coverage with adequately iodized salt than previous surveys.

The inclusion of children 5-9 years of age and adolescent girls enables for the first time a comprehensive
assessment of the nutritional status in these age groups. Survey planners expected difficulty in enrolling
children 5-9 years of age and adolescent girls because they would be away from home for much of the day.
However, contrary to these expectations, their inclusion did not prove to be a major difficulty because field
teams adjusted their work schedules to the school schedules of eligible children and girls. This meant
sometimes returning to a household later in the day after children or girls had returned home from school.
Overall response rates in both age groups were satisfactory. Another challenge when including children 5-9
years of age and adolescent girls in a nutrition survey is the interpretation of laboratory testing results. For
several blood biomarkers, no established cutoff points defining normal values exist for children 5-9 years
of age. Although there are WHO-recommended cut-off points to define anemia and iron deficiency [36,38],
there are no recommended cut-off points for defining minimum dietary diversity, vitamin A, vitamin D, or
folate deficiencies. Where available, we used cut-off points from biomedical literature, or, when lacking, cut-
off points recommended for other population groups.

Similar to the 2009 micronutrient survey, the NIMAS collected venous blood samples, which removed potential
pre-analytical biases, which can occur with capillary sampling, such as the potential of sample dilution
from interstitial fluid. Moreover, both surveys measured hemoglobin concentrations on a portable device
(HemoCue 301). The anemia prevalence between the two surveys are comparable and importantly, are much
lower than reported in the DHS 2012. The DHS used capillary blood to measure hemoglobin on a different
portable hemoglobinometer (Hemocue 201+). As previously noted, recent research indicates that hemoglobin
measurements from capillary blood samples and the HemoCue 201+ yield reduced hemoglobin concentrations
and thus, increased an anemia prevalence. On the other hand, there is some evidence that the HemoCue 301
device yields slightly increased hemoglobin concentration and thus a lower anemia prevalence. To validate
the hemoglobin results obtained from the HemoCue 301, the NIMAS measured hemoglobin on a complete
blood counter in a sub-sample of children 6-59 months of age, children 5-9 years of age, adolescent girls
and non-pregnant women. The mean hemoglobin concentration measured by the CBC is 4g/L (~3%) lower
than the concentration obtained by the HemoCue 301 across all population groups. Hence, though the actual
prevalence of anemia might be slightly higher than estimated, the classification of public health significance
of anaemia would remain.

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6. RECOMMENDATIONS

Using the findings presented in this report and an understanding of the Kyrgyz Republic’s programmatic and
research environment, the following programmatic and research recommendations have been developed.
While these recommendations describe policy and programmatic options that can be taken, they do not specify
what governmental or non-governmental agencies are responsible for addressing each recommendation.
Moving forward, nutrition stakeholders in the Kyrgyz Republic, including the Scale Up Nutrition (SUN) Multi-
Stakeholder Platform should review these recommendations to determine which agencies are best placed to
address certain issues and improve the nutrition situation of children and women in the Kyrgyz Republic.

6.1. Reduce poverty

Many international organizations, such as FAO, WB, WFP, UNDP, Mercy Corps and UNICEF are actively
supporting the Government of the Kyrgyz Republic combating poverty in the Kyrgyz Republic. In 2018, the Kyrgyz
government and WFP jointly implemented a programme to deliver school meals, provide food assistance and
cash based transfers, support poor smallholder farmers, build resilience to shocks, and strengthen climate
change adaptation [88]. Nevertheless, the proportion of households living under the poverty line remains high
and is expected to further increase mainly due to the crisis in Ukraine and the ongoing pandemic, the effects
of climate change, rising food prices, poor job opportunities, and a continued cooling of the economy [89].
Existing programs must be adapted to the current situation in order to counteract a further increase in poverty
and, if possible, reduce the number of people living below the poverty line. This could include the expansion of
social safety net programs, such as food and cash and voucher assistance to vulnerable households. The multi-
sectoral nature of the integrated approach still depends on bringing together social protection stakeholders
with agricultural stakeholders and services in a coherent and sustainable way, to ensure poor smallholder
households can increase their capacity to produce, diversify their diets and income and sustainably move out
of poverty. Indeed, despite the fact that social protection programs have been shown to improve household food
security and nutrition, and there is evidence that these programs are strengthened when incorporating food
and nutrition education, there are important knowledge gaps regarding the operational options of linking them
with broader agricultural interventions. Alternatively, new programs to reduce poverty can be designed to meet
the Kyrgyz Republic’s economic and seasonal conditions to increase households’ food security throughout
the year. Development of the new Food Security and Nutrition Programme in the Kyrgyz Republic would
enable multiple stakeholders to work towards agreed set of results and allocation of responsibilities for their
implementation and achievement among different sectors.

6.2. Improve household access to food

Household food insecurity is a leading risk factor of multiple forms of malnutrition. The NIMAS data found
that household food security status is significantly associated with wasting and iron deficiency anemia among
children 6-59 months of age, thinness, anemia and iron deficiency among children 5-9 years of age, and
vitamin A deficiency in non-pregnant women 15-49 years of age. Moreover, food security status is associated
with dietary diversity in children 6-23 months of age, children 5-9 years of age, and non-pregnant women 15-
49 years of age, showing that household level food security plays an important role in ensuring good quality
nutrition for nutritionally vulnerable household members. It is therefore recommended that policies and
programmes aimed at reducing malnutrition should include interventions to address households’ access to
healthy and nutritious food.

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6.3. Amend the salt iodization law

The NIMAS generally found that adolescent girls, non-pregnant women, and pregnant women have adequate
iodine status, indicating that the iodization programme is functioning well. Sub-group analyses, however,
reveal a relatively large variation in urinary iodine: pregnant women living in wealthy households with low
median iodine concentration and non-pregnant adolescent girls in Talas and young pregnant women being on
the edge of excess iodine intake. To reduce that variability and have a more consistent iodine intake it would
make sense to consider aligning the national fortification threshold with the international cut-off of 15ppm and
strengthen the law enforcement at the level of salt production, importation, and distribution. Moreover, since
the iodine status of the population is at the high end of adequacy, programs designed to reduce salt intake
would not have a serious effect on iodine status.

6.4. Strengthen wheat flour fortification

Although anemia was found to be a moderate public health problem in the Kyrgyz Republic, the prevalence of
iron deficiency was high. As iron deficiency was significantly associated with anemia, addressing iron deficiency
could likely reduce the anemia prevalence. Fortification of wheat flour has been shown to reduce the prevalence
of iron deficiency and folate deficiency in Central Asia [22], and has been proven a successful approach to reduce
birth defects [90]. Findings of the NIMAS reveal that only one third of the flour is fortified with iron and less
than 2% of the flour is fortified according to the standards, with only marginal differences between the locally
produced and the imported flour. Therefore, adherence to fortification standards of locally-produced wheat
flour should be strengthened at the level of production and distribution, and monitoring activities for imported
flour should be extended to enforce appropriate fortification of imported flour. In addition, the government of
the Kyrgyz Republic should consider the possibility of creating economic incentives for flour producers; direct
purchase and distribution of premix from the state budget and/or creation of a revolving fund are two potential
methods to create economic incentives for fortification.

Law enforcement, taking into consideration the accession of the Kyrgyz Republic into Eurasian Economic Union,
would also be expected to increase coverage with adequately fortified wheat flour and to provide additional
micronutrients. If both recommendations are implemented, reduction of anemia, iron and folate deficiencies
is plausible. Moreover, adding vitamin D to the fortification program might then be a viable strategy to combat
vitamin D deficiency. Lastly, public awareness of the positive effects of consuming fortified flour remains low
because there is no strategy to inform the public and other parties involved about the importance of fortified
flour. The ‘Report on Monitoring the Implementation of the Bakery Flour Fortification Law’ (2017) state that
83.2 percent never check whether the flour is fortified or not when buying flour. To create demand for fortified
flour it is recommended to develop a national communication strategy on nutrition.

6.5. Reduce the prevalence of overweight and obesity

Overweight and obesity is a public health problem with medium relevance in young children and a serious public
health concern in women, particularly in older women and should be addressed through governmental policies
and programs. According to the WHO, though numerous societal and environmental factors influence weight
gain and retention, “dietary factors and physical activity patterns are considered to be the major modifiable
factors underlying excessive weight gain that, if corrected, can serve to prevent obesity”[91]. Programs
targeted to pregnant and lactating women are also an entry point for reducing overweight and obesity in young
children as well as adult women, as postpartum weight retention is a risk factor of long term overweight and
obesity [92]. It is thus recommended that antenatal and postnatal care be expanded to include behavior change
messages and counselling for mothers. Further, it is advisable to ideally instil appropriate eating behaviors
early in life, since such changes are often more easily induced in younger people. As such schools could provide
the platform to deliver messages about good nutrition and provide nutrition education to school age children
and adolescent girls. Moreover, children of all ages have unique, age-specific nutritional needs, problems, and
challenges, and healthy child growth and development also require adequate nutrition before conception and
during pregnancy and lactation. Considering these needs and challenges across the life cycle, development of
food-based dietary guideline to educate consumers on healthy diets and provide direction for programs and
policies aiming to ensure healthy diets for all is critical. Further, to support consumers to make informed food
purchases and healthier eating choices, front-of-pack labelling of ultra-processed foods and beverages high in

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salt, sugar and/or fat is needed. Another recommendation is to set up the epidemiological surveillance of non-
communicable diseases, as this could help policy makers to a) identify the health outcomes (e.g., diabetes,
cardiovascular diseases) caused by overweight and obesity, and b) plan and implement programs to prevent
non-communicable diseases and the risk factors (e.g., overweight and obesity) of non-communicable diseases.

6.5.1. Strengthen other strategies to tackle micronutrient deficiencies

To increase the vitamin A stores in the overall population, policy makers should consider implementing
a vitamin A fortification program. Vegetable oil is an ideal vehicle for vitamin A fortification as it protects
vitamin A from oxidation during storage and might be a suitable vehicle in the Kyrgyz Republic since it is
consumed in adequate amounts. To achieve a high coverage with fortified vegetable oil, regulatory importation
requirements will have to be set in place, similar to those for fortified wheat flour, since a significant proportion
of the vegetable oil consumed in the Kyrgyz Republic is imported. Other staple foods widely used for vitamin
A fortification and potentially suitable for the Kyrgyz Republic are wheat flour and sugar since they are widely
consumed. However, food fortification of staple foods may not be the most appropriate approach to reach
young children 6-23 months of age; since their caloric intake is limited compared against their micronutrient
need, programs to provide micronutrient powders may be envisioned to tackle iron and vitamin A deficiencies
in young children. As The Kyrgyz Republic has successfully implemented a micronutrient powder program in
the past, insights from programmers and policy makers from the previous program should be sought.

Moreover, campaigns that raise the awareness of folate, vitamin A and iron deficiencies and promote the
consumption of nutrient rich foods should be implemented. This type of intervention could include promoting
local food products rich in micronutrients.

Lastly, supplementation is a viable, though more costly, alternative to fortification to address micronutrient
deficiencies. Overall, vitamin and mineral supplement consumption is low in women and children. It is
therefore recommended that the Kyrgyz Republic’s health system promote and expand the distribution of these
supplements to achieve a high level of coverage and consumer compliance. General awareness campaigns can
also be considered but should only be conducted when distribution channels are in place guaranteeing access
to supplements. Universal iron and folic acid (IFA) supplementation for anemia prevention among pregnant
women is one high impact intervention to improve maternal survival and gestational outcomes. To increase
the coverage of IFA supplement consumption, pregnant women can be targeted at their prenatal and postnatal
care visits. Moreover, the drastic increase in vitamin A deficiency since 2009 clearly indicates that a functioning
vitamin A supplementation program can counteract the development of vitamin A deficiency. In addition,
vitamin A supplementation would strengthen children’s immune systems and reduce the risk of mortality
due to measles, diarrhea, and other illnesses. For easier implementation, consider linking the vitamin A
supplementation with vaccination programs in order to achieve a high vitamin A supplementation coverage.

6.5.2. National Nutrition Information System

A national surveillance system that facilitates monitoring of maternal, newborn and infant nutritional health
status should be developed. Such a system would enable policy makers and stakeholders to track various
health outcomes on a regular basis and could be used to monitor the health impact of nutrition and health
programs. Such a system should include a suite of indicators that are internationally recognized and can be
readily collected from health facilities. Ideally, data in this system would be disaggregated by socioeconomic
status and other variables and reported routinely.

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8. World Bank. Disease Control Priorities: Improving Health and Reducing Poverty, 3rd edition. Washington
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8. APPENDICES

8.1. ADDITIONAL HOUSEHOLD TABLES

Table 87. Distribution of household interview results for households randomly selected for participation, the
Kyrgyz Republic 2021

No household Entire
member or household
Dwelling
Interview competent absent for Interview
vacant or Otherb
completed respondent at long period refused
not found
home during or moved
visit away
Characteristic N %a N %a N %a N %a N %a N %a
Residence
Urban 1370 86.2 17 1.1 62 3.9 111 7 1 0.1 29 1.8
Rural 1692 90.9 11 0.6 45 2.4 66 3.5 4 0.2 44 2.4
Region
Batken oblast 298 89.8 2 0.6 18 5.4 11 3.3 2 0.6 1 0.3
Jalal-Abad 321 87 0 0 21 5.7 11 3 0 0 16 4.3
oblast
Issyk-Kul oblast 352 86.5 22 5.4 5 1.2 14 3.4 0 0 14 3.4
Naryn oblast 312 90.4 0 0 1 0.3 9 2.6 0 0 23 6.7
Osh oblast 332 92.2 0 0 3 0.8 13 3.6 0 0 12 3.3
Talas oblast 283 94.6 0 0 1 0.3 15 5 0 0 0 0
Chui oblast 308 83.7 0 0 22 6 35 9.5 2 0.5 1 0.3
Bishkek city 476 86.2 2 0.4 22 4 49 8.9 0 0 3 0.5
Osh city 380 90.5 2 0.5 14 3.3 20 4.8 1 0.2 3 0.7
TOTAL 3062 88.7 28 0.8 107 3.1 177 5.1 5 0.1 73 2.1
Note: The N’s are the denominators for a specific sub-group.
a Percentages not weighted for unequal probability of selection.
b
Other: included dwelling destroyed or other reasons noted by interviewer.

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Table 88. Agricultural land and livestock of participating households, Kyrgyzatan 2021

Characteristic N %a (95% CI)b

Member of household owns any agricultural land

Yes 1497 51.5 (48.8, 54.3)

No 1565 48.5 (45.7, 51.2)

Average size of agricultural land

Mean (hectare)c 1440 18.5 (10.8, 26.1)

Household owns any livestock

Yes 1416 46.0 (43.3, 48.8)

No 1646 53.8 (51.0, 56.6)

Household owns livestock, specificd

Cattle 1416 75.0 (71.8, 78.0)

Horses, donkeys, mules 1416 23.9 (20.3, 27.8)

Goats 1416 13.4 (10.9, 16.4)

Sheep 1416 47.7 (43.8, 51.6)

Pigs 1416 0.4 (0.2, 1.0)

Chicken 1416 59.7 (56.3, 63.1)

Other poultry 1416 4.1 (2.5, 6.6)

Note: The N’s are the denominators for a specific sub-group.

a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval calculated taking into account the complex sampling design.
C
N for mean hectares is not equal to 1497 as some respondents (n=57) did not know the size of their household’s agricultural land
holdings.
d
Question only asked to households responding “Yes” to livestock ownership

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 Table 89. Household food insecurity score (HFIAS) categories, by residence, region, and wealth quintile, the Kyrgyz Republic 2021

Food secure, Mild food Moderate food Severe food

Characteristic N (95% CI)b (95% CI)b (95% CI)b (95% CI)b
%a insecurity, %a insecurity, %a insecurity, %a
Residence
Urban 1691 68.1 (65.1, 71.0) 10.3 (8.8, 11.9) 15.0 (12.9, 17.2) 6.7 (5.4, 8.2)
Rural 1370 73.9 (70.0, 77.4) 9.8 (7.9, 12.1) 12.5 (10.6, 14.8) 3.8 (2.6, 5.6)
Region
Batken oblast 298 77.4 (70.8, 82.9) 8.0 (4.8, 13.0) 9.4 (6.3, 14.0) 5.1 (2.8, 9.2)
Jalal-Abad oblast 320 85.3 (79.4, 89.8) 8.4 (5.5, 12.8) 5.3 (3.0, 9.3) 0.9 (0.3, 2.8)
Issyk-Kul oblast 352 56.4 (49.7, 62.9) 16.0 (12.0, 21.0) 21.0 (17.1, 25.6) 6.6 (3.9, 10.8)
Naryn oblast 312 53.2 (49.0, 57.3) 16.7 (12.6, 21.9) 21.5 (18.0, 25.3) 8.6 (6.2, 11.8)
Osh oblast 332 75.2 (69.4, 80.3) 5.4 (3.6, 8.0) 13.1 (9.1, 18.6) 6.2 (4.5, 8.6)
Talas oblast 283 60.4 (53.9, 66.4) 14.9 (12.0, 18.3) 18.6 (14.7, 23.3) 6.2 (3.8, 9.9)
Chui oblast 308 52.2 (46.8, 57.7) 14.6 (11.3, 18.7) 22.1 (18.1, 26.6) 11.0 (7.8, 15.5)
Bishkek city 476 78.5 (73.2, 83.0) 7.0 (4.7, 10.1) 11.8 (9.3, 15.0) 2.7 (1.3, 5.7)
Osh city 380 73.7 (69.4, 77.6) 11.0 (8.1, 14.8) 9.5 (6.8, 13.0) 5.8 (3.7, 9.0)
Wealth quintile
Lowest 686 53.4 (48.6, 58.2) 11.2 (8.8, 14.3) 21.6 (18.3, 25.3) 13.7 (10.6, 17.7)
Second 594 65.6 (61.1, 69.8) 12.2 (9.6, 15.4) 16.9 (13.6, 20.7) 5.4 (3.8, 7.6)
Middle 572 76.2 (72.6, 79.5) 9.8 (7.5, 12.6) 11.0 (8.4, 14.3) 3.0 (1.7, 5.4)
Fourth 603 77.1 (72.7, 80.7) 9.8 (7.4, 12.9) 9.7 (7.4, 12.5) 3.6 (2.2, 5.8)
Highest 606 79.9 (74.6, 84.3) 7.4 (5.0, 10.9) 10.8 (8.2, 14.0) 2.0 (1.1, 3.4)
TOTAL 3061 70.4 (68.3, 72.4) 10.1 (8.69, 11.3) 14.0 (12.6, 15.5) 5.5 (4.6, 6.6)
Note: Note: The N’s are the denominators for a specific sub-group; the sum of subgroups may not equal the total because of missing data.
a
Percentages weighted for unequal probability of selection.
b
CI=confidence interval, calculated taking into account the complex sampling design.
c
Chi-square p-value <0.05 indicates that the proportion in at least one subgroup is statistically significantly different from the values in the other subgroups.

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 8.2. ADDITIONAL CHILD TABLES

166
Table 90. Proportion of mild, moderate and severe anemia in children 6-59 months of age, the Kyrgyz Republic 2021

Severe anemia Moderate anemia Mild anemia

a, b c d a, b c d a, b
Characteristic N % (95% CI) p-value % (95% CI) p-value % (95% CI)c p-valued
Age Group (in months)
6-11 120 0 (0, 0) 0.656 14.7 (8.8, 23.6) <0.001 22.2 (13.6, 34.0) <0.001
12-23 240 0.4 (0.1, 2.7) 15.0 (8.7, 24.5) 21.0 (16.4, 26.5)
24-35 302 0.4 (0.1, 1.6) 7.2 (4.4, 11.5) 15.0 (10.8, 20.5)
36-47 283 0 (0, 0) 2.0 (0.8, 4.9) 10.7 (6.6, 16.8)
48-59 265 0 (0, 0) 2.4 (1.1, 5.1) 5.0 (2.7, 9.0)
Sex
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Male 593 0.3 (0.1, 1.1) 0.093 6.5 (4.4, 9.4) 0.513 13.8 (10.9, 17.4) 0.822
Female 614 0 (0, 0) 7.8 (4.8, 12.3) 13.3 (10.2, 17.1)
Residence
Urban 452 0.3 (0, 1.8) 0.594 4.9 (2.5, 9.3) 0.189 8.9 (6.6, 12.0) 0.002
Rural 759 0.1 (0, 0.5) 8.1 (5.5, 11.7) 15.6 (12.7, 18.9)
Region
Batken oblast 172 0 (0, 0) 0.057 3.5 (1.1, 10.7) 0.005 16.5 (11.6, 22.9) 0.032
Jalal-Abad oblast 164 0 (0, 0) 2.1 (0.7, 5.8) 9.0 (5.5, 14.3)
Issyk-Kul oblast 118 1.8 (0.4, 7.4) 18.8 (11.2, 29.8) 13.3 (8.4, 20.5)
Naryn oblast 141 0 (0, 0) 9.6 (5.1, 17.3) 23.2 (16.5, 31.5)
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Osh oblast 140 0 (0, 0) 6.8 (3.0, 14.6) 15.4 (10.1, 22.8)
Talas oblast 120 0.9 (0.1, 6.2) 13.6 (7.9, 22.2) 18.7 (12.0, 27.9)
Chui oblast 76 0 (0, 0) 12.3 (4.8, 28.3) 16.9 (10.3, 26.3)
Bishkek city 90 0 (0, 0) 3.5 (1.0, 11.5) 7.3 (3.6, 14.4)
Osh city 190 0 (0, 0) 3.2 (1.5, 6.6) 8.5 (4.3, 16.0)
Wealth quintile
Lowest 294 0.4 (0.1, 1.7) 0.448 11.8 (6.3, 21.0) 0.092 15.5 (11.1, 21.2) 0.329
Second 272 0 (0, 0) 4.1 (2.4, 6.8) 13.3 (9.1, 18.9)
Middle 274 0 (0, 0) 6.9 (3.9, 12.1) 16.3 (11.7, 22.3)
 Fourth 230 0 (0, 0) 7.1 (4.0, 12.3) 11.1 (7.0, 17.2)
Highest 137 0.8 (0.1, 5.8) 5.1 (1.9, 12.7) 8.3 (4.3, 15.5)
Household sanitationg
Unadequate 187 0 (0, 0) 0.472 1.4 (0.4, 4.8) 0.002 10.6 (6.2, 17.7) 0.306
Adequate 1019 0.2 (0.1, 0.7) 8.3 (5.9, 11.5) 14.2 (11.8, 17.0)
TOTAL 1211 0.2 (0.1, 0.6) 7.1 (5.1, 9.9) 13.6 (11.4, 16.1)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
Severe anemia: <70 g/L, moderate anemia: 70-99 g/L, mild anemia: 100-109 g/L; all adjusted for altitude.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P-value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another household.
Inadequate sanitation= open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field.

8.3. ADDITIONAL SCHOOL CHILD TABLES

Table 91. Proportion of mild, moderate and severe anemia in school children 5-9 years of age, the Kyrgyz Republic 2021

Severe anemia Moderate anemia Mild anemia

Characteristic N
%a, b (95% CI)c p-valued %a, b (95% CI)c p-valued %a, b (95% CI)c p-valued
Age Group (in months)
5 274 0 (0, 0) 0.759 8.0 (5.2, 12.3) <0.05 7.7 (4.5, 12.8) <0.005
6 289 0 (0, 0) 3.8 (2.1, 7.0) 3.9 (2.0, 7.5)
7 275 0.2 (0, 1.3) 4.3 (2.2, 7.9) 1.7 (0.9, 3.2)
8 282 0 (0, 0) 2.4 (0.9, 6.4) 1.0 (0.3, 3.6)
9 279 0 (0, 0) 3.1 (1.6, 6.1) 3.0 (1.4, 6.2)
Sex
Male 697 0 (0, 0) 0.326 3.7 (2.3, 5.8) 0.272 4.0 (2.6, 6.2) 0.329
Female 700 0.1 (0, 0.5) 4.9 (3.1, 7.6) 2.9 (1.8, 4.6)
Residence
Urban 473 0.1 (0, 0.9) 0.125 4.8 (3.0, 7.5) 0.671 3.8 (2.2, 6.6) 0.634
Rural 928 0 (0, 0) 4.1 (2.5, 6.7) 3.3 (2.2, 4.7)

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REPORT- OCTOBER 2022
 Region

168
Batken oblast 220 0 (0, 0) 0.385 1.7 (0.7, 4.2) 0.648 2.6 (1.0, 6.3) <0.01
Jalal-Abad oblast 165 0 (0, 0) 3.8 (1.9, 7.6) 0.5 (0.1, 3.6)
Issyk-Kul oblast 151 0 (0, 0) 6.9 (3.3, 14.0) 2.8 (1.1, 7.0)
Naryn oblast 164 0 (0, 0) 7.0 (3.8, 12.6) 4.1 (1.7, 9.5)
Osh oblast 203 0 (0, 0) 4.8 (2.1, 10.6) 3.5 (1.8, 6.7)
Talas oblast 160 0.6 (0.1, 4.4) 2.5 (1.0, 5.7) 11.7 (6.0, 21.7)
Chui oblast 103 0 (0, 0) 5.0 (1.3, 17.1) 4.5 (1.9, 10.0)
Bishkek city 83 0 (0, 0) 3.8 (1.5, 9.5) 3.2 (1.0, 10.0)
Osh city 152 0 (0, 0) 2.9 (1.1, 7.6) 3.1 (1.4, 6.8)
Wealth quintile
Lowest 402 0.1 (0, 1.0) 0.934 3.4 (1.9, 6.1) 0.692 4.1 (2.4, 6.8) 0.208
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Second 318 0 (0, 0) 4.5 (2.6, 7.8) 4.6 (2.4, 8.8)

Middle 310 0 (0, 0) 5.7 (2.7, 11.4) 2.0 (0.8, 4.9)
Fourth 239 0 (0, 0) 3.4 (1.6, 6.9) 4.3 (2.1, 8.4)
Highest 127 0 (0, 0) 4.7 (2.0, 10.9) 0.7 (0.2, 3.0)
g
Household sanitation
Unadequate 212 0 (0, 0) 0.682 1.3 (0.4, 4.0) <0.05 2.4 (1.0, 5.7) 0.385
Adequate 1180 0 (0, 0.3) 4.8 (3.3, 7.0) 3.6 (2.6, 5.0)
ALL CHILDREN 1401 0 (0, 0.3) 4.3 (3.0, 6.2) 3.4 (2.5, 4.7)
Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

b
Severe anemia: <80 g/L, moderate anemia: 80-109 g/L, mild anemia: 110-115 g/L; all adjusted for altitude.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
hold. Inadequate sanitation= open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field.
 8.4. ADDITIONAL ADOLESCENT GIRL TABLES
Table 92. Proportion of mild, moderate and severe anemia in adolescent girls 10-18 years of age, the Kyrgyz Republic 2021

Severe anemia Moderate anemia Mild anemia

Characteristic N a, b c d a, b c d a, b
% (95% CI) P value % (95% CI) P value % (95% CI)c P valued
Age Group (in years)
10-12 374 1.1 (0.0, 3.1) 0.237 3.0 (1.5, 5.8) <0.001 3.6 (1.6, 8.0) <0.05
13-15 309 0 (0, 0) 8.0 (5.0, 12.5) 9.9 (6.9, 14.0)
16-18 175 0.8 (0.1, 5.8) 13.6 (8.1, 21.8) 9.7 (5.7, 16.2)
Residence
Urban 262 0.3 (0, 1.8) 0.256 6.9 (4.0, 11.6) 0.984 7.7 (4.1, 14.1) 0.754
Rural 596 0.8 (0.3, 2.1) 6.8 (4.6, 10.0) 6.9 (4.8, 9.8)
Region
Batken oblast 104 0 (0, 0) 0.714 6.6 (3.1, 13.5) 0.645 9.3 (4.4, 18.5) 0.838
Jalal-Abad oblast 112 1.6 (0.4, 5.9) 8.2 (3.7, 17.1) 6.2 (3.4, 11.1)
Issyk-Kul oblast 89 0 (0, 0) 9.3 (4.6, 18.0) 7.4 (2.4, 20.9)
Naryn oblast 156 1.2 (0.3, 4.8) 7.7 (4.4, 13.0) 7.0 (4.2, 11.5)
Osh oblast 121 0.8 (0.1, 5.4) 3.4 (1.1, 9.8) 4.4 (2.1, 9.1)
Talas oblast 84 0 (0, 0) 4.9 (2.1, 10.6) 11.6 (5.0, 24.6)
Chui oblast 63 0 (0, 0) 9.4 (4.0, 20.5) 8.9 (3.6, 20.4)
Bishkek city 35 0 (0, 0) 6.8 (2.1, 19.9) 8.7 (1.7, 34.0)
Osh city 94 1.4 (0.2, 9.8) 5.3 (2.4, 11.5) 6.1 (2.4, 14.0)
Wealth quintile
Lowest 262 0.6 (0.1, 4.0) 0.714 6.7 (4.1, 10.9) 0.071 7.0 (4.0, 11.8) 0.693
Second 201 0.7 (0.1, 4.8) 11.7 (6.8, 19.5) 5.6 (3.2, 9.7)
Middle 154 1.3 (0.3, 5.0) 2.9 (1.1, 7.0) 10.5 (5.8, 18.0)
Fourth 147 0 (0, 0) 6.1 (2.7, 13.6) 6.3 (3.2, 12.1)
Highest 85 0.7 (0.1, 4.9) 4..3 (1.3, 13.5) 6.9 (1.5, 27.1)
Household sanitation
Yes 119 2.3 (0.6, 8.4) <0.05 3.7 (1.1, 11.5) 0.251 4.3 (1.7, 10.3) 0.223
No 734 0.4 (0.1, 1.3) 7.4 (5.0, 10.3) 7.6 (5.5, 10.5)

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REPORT- OCTOBER 2022
 TOTAL 852 0.6 (0.3, 1.6) 6.8 (4.9, 9.4) 7.1 (5.2, 9.7)

170
a
All percentages except region-specific estimates are weighted for unequal probability of selection among regions.
b
< 12 years: Severe anemia: <80 g/L, moderate anemia: 80-109 g/L, mild anemia: 110-115 g/L; ≥12 years: Severe anemia: <80 g/L, moderate anemia: 80-109 g/L, mild anemia: 110-119 g/L; all adjusted
for altitude.
c
CI=confidence interval, calculated taking into account the complex sampling design.
d
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.
e
Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
hold. Inadequate sanitation= open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field.

8.5. ADDITIONAL WOMAN TABLES

Table 93. Proportion of mild, moderate, and severe anemia in non-pregnant women (15-49 years), the Kyrgyz Republic 2021
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Severe anemia Moderate anemia Mild anemia

Characteristic N a, b c d a, b c d a, b
% (95% CI) P value % (95% CI) P value % (95% CI)c P valued
Age Group (in years)
15-19 281 0.5 (0.1, 3.4) 0.128 13.0 (8.7, 18.9) 0.436 14.5 (10.4, 19.9) 0.083
20-29 262 0.6 (0.1, 2.5) 8.2 (5.2, 12.8) 13.8 (9.4, 19.7)
30-39 375 0.6 (0.2, 1.6) 11.9 (8.5, 16.3) 15.4 (11.9, 19.6)
40-49 285 2.1 (0.9, 4.9) 11.7 (8.4, 16.2) 8.2 (5.4, 12.2)
Residence
Urban 471 0.9 (0.3, 2.8) 0.989 12.3 (9.2, 16.3) 0.463 11.8 (8.9, 15.5) 0.340
Rural 732 0.9 (0.5, 1.8) 10.7 (8.3, 13.7) 13.9 (11.3, 17.0)
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Region
Batken oblast 140 1.4 (0.4, 5.5) 0.501 10.2 (5.8, 17.2) 0.133 21.2 (13.9, 31.1) 0.297
Jalal-Abad oblast 145 1.2 (0.3, 4.6) 7.5 (3.8, 14.4) 14.3 (8.7, 22.6)
Issyk-Kul oblast 120 2.6 (0.9, 7.3) 16.7 (9.5, 27.7) 15.5 (10.0, 23.2)
Naryn oblast 147 1.3 (0.4, 4.8) 14.2 (8.1, 23.8) 17.0 (12.8, 22.2)
Osh oblast 150 0 (0, 0) 7.6 (4.5, 12.5) 9.8 (5.9, 15.8)
Talas oblast 123 1.5 (0.4, 5.8) 18.7 (12.1, 27.7) 11.9 (6.6, 20.4)
Chui oblast 93 0.8 (0.1, 5.8) 10.4 (5.9, 17.6) 12.6 (8.2, 18.8)
Bishkek city 133 0.6 (0.1, 3.8) 14.7 (9.2, 22.6) 10.8 (6.8, 16.8)
Osh city 152 0.6 (0.1, 4.5) 13.1 (8.2, 20.1) 13.0 (8.6, 19.2)
 REPORT- OCTOBER 2022

8.6. COMPARISON OF PLASMA

Composite variable of toilet type and if toilet facilities are shared with non-household members; Adequate Sanitation = flush or pour flush toilet or pit latrine with slab not shared with another house-
RETINOL AND PLASMA RETINOL

0.719
0.192

BINDING PROTEIN
Because retinol binding protein (RBP) is not a WHO-

(11.1, 15.5)
(11.1, 15.8)
(13.1, 24.9)

(8.2, 17.7)
(6.3, 15.7)

(8.1, 18.2)
(8.7, 18.9)
(7.9, 16.7)

recommended biomarker for the assessment of

vitamin A status [37], extra plasma specimens
from children 6-59 months of age, children 5-9
years of age, and non-pregnant adolescent girls
and women (AG-NPW) were analyzed for plasma
13.1
12.2
10.0

12.3
13.3
11.6
18.3
13.0

retinol as a comparison and validations of RBP

measurements. Analysis of plasma retinol was
undertaken at two laboratories: 1) VitMin Lab
(Freiburg, Germany), which is the same laboratory
0.680
0.195

that measured RBP, and 2) the Swiss Nutrition and

Health Foundation (SNH) laboratory (Lausanne,
Switzerland), an independent laboratory that has
a demonstratable external quality assurance track
(10.6, 20.8)

(9.3, 13.6)
(5.9, 18.2)

(6.2, 16.2)
(9.2, 13.9)
(7.0, 15.4)
(8.5, 17.9)
(4.4, 11.6)

record of analyzing plasma retinol.

The VitMin Lab analyzed retinol using aliquots

that had remaining plasma volume, and samples
with remaining plasma volume were transported
frozen by GroundWork using frozen salt water
11.3
10.1
10.6

11.3
10.5
15.0
12.5
7.2

Note: The N’s are the denominators for a specific sub-group. Subgroups that do not sum to the total have missing data.

packs (-20°C) from VitMin Lab to SNH. As the

All percentages except region-specific estimates are weighted for unequal probability of selection among regions.

transit time for the samples was very small (~4

hours) and the samples were frozen throughout,
0.040
0.315

Severe anemia: <80 g/L, moderate anemia: 80-109 g/L, mild anemia: 109-119 g/L; all adjusted for altitude.

there was no risk of degradation. Furthermore, as

the same aliquot was used for the measurement
P value <0.05 indicates that at least one subgroup is statistically significantly different from the others.

of both biomarkers, there is no possibility of

labelling errors, which is a potential issue faced by
hold. Inadequate sanitation= open pit, bucket latrine, hanging toilet/latrine, no facility, bush, field.
(0.5, 1.6)
(0.9, 5.8)
(0.3, 1.4)
(0.4, 4.6)
(0.8, 4.2)
(0.3, 2.3)
(0.1, 3.4)

other large-scale surveys that compare RBP and

(0, 0)

retinol results. In addition, both laboratories used

the same analytic method (i.e., HPLC) to measure
CI=confidence interval, calculated taking into account the complex sampling design.

retinol concentrations in the plasma samples. As

mentioned in Section 2.6.2, RBP was measured
0.9
2.2
0.7
1.3
1.8
0.8
0.5

using the ELISA technique by VitMin Lab.

Figure 31 below presents the correlation plot and

regression equation comparing retinol and RBP
1203
1011
184
279
266
228
235
191

for both children and women combined. The figure

displays the Retinol/RBP comparisons that were
conducted using results from the SNH and VitMin
laboratories (SNH-VitMin) and the comparisons
using the results from VitMin Lab alone (VitMin-
Internal) for each population group. Using 136
cases (42 PSC, 50 SAC, 44 AG-NPW), we found a
good correlation between RBP and plasma retinol
values (R2=0.84). The estimated slope was 0.8025,
showing that RBP values were consistently lower
than their plasma retinol counterparts in both
Household sanitation

laboratories.

Based on these results, the vitamin A deficiency

Wealth quintile

cut-off was adjusted for RBP. Using the WHO

ALL WOMEN
Unadequate

recommended cut-off [37] for retinol of 0.7 µmol/L

Adequate

and the regression equation in Figure 31, the

Highest
Second
Lowest

Middle
Fourth

RBP cut-off was calculated to be 0.56885 µmol/L

[(0.8025 × 0.7) + 0.0071 = 0.56885].
b

e
a

171
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Similar results were obtained when a regression equation was calculated separately for each laboratory
comparison (i.e., SNH-VitMin or VitMin-Internal), resulting in RBP cut-offs of 0.555 0.590 µmol/L, respectively.

Kyrgyz NIMAS - Comparison of RBP and Retinol

1,8
1,6
1,4
1,2
RBP (μmol/L)

1,0
0,8
0,6
0,4
0,2
0,0
0,0 0,2 0,4 0,6 0,8 1,0 1,2 1,4 1,6 1,8
Retinol (μmol/L)

PSC: SNH-Vitmin PSC: Vitmin Internal

AG-NPW: SNH-Vitmin AG-NPW: Vitmim Internal
SAC: SNH-Vitmin SAC: Vitmin Internal
Linear (Combined) Linear (slope=1)

Figure 31. Combined comparison of retinol and retinol binding protein concentrations in children 6-59
months of age (PSC), children 5-9 years of age (SAC), and adolescent girls and non-pregnant women (AG-
NPW), the Kyrgyz Republic 2021

172
 8.7. HEMOGLOBIN COMPARISON – HEMOCUE 301 AND COMPLETE BLOOD COUNT

20 20

15 15

10 10 y = 1.0564x - 1.0552
y = 1.0235x - 0.7475
R2 = 0.8737 R2 = 0.9072
5 5

Aqualab Hb (g/dL)
Aqualab Hb (g/dL)
0 0
0 5 10 15 20 0 5 10 15 20
Hemocue Hb (g/dl) Hemocue Hb (g/dl)
PSC Linear (PSC) SAC Linear (SAC)

20 20

15 15

10 10

y = 0.9481x - 0.2042
5 y = 0.8972x - 0.7935 5
Aqualab Hb (g/dL)

Aqualab Hb (g/dL)
R2 = 0.7668
R2 = 0.7025
0 0
0 5 10 15 20 0 5 10 15 20
Hemocue Hb (g/dl) Hemocue Hb (g/dl)
WRA Linear (WRA) PSC SAC WRA Linear (Combined)

Figure 32. Comparison of hemoglobin measured using Hemocue 301 and complete blood count in in children 6-59 months of age (PSC), children 5-9 years of age
(SAC), and women of reproductive age (WRA), the Kyrgyz Republic 2021

173
REPORT- OCTOBER 2022
 8.8. A PRIORI SAMPLE SIZE CALCULATIONS

174
Table 93 shows the precision that will be obtained for stratum specific and national anemia estimates with the planned sample size of 3465 households selected
for the survey if the assumptions regarding the anemia prevalence hold true. Estimated prevalence and design effect are from most recently available data. These
estimates assume a design effect of 1.5 and the recruitment of children 6-59 months of age, school children and adolescent girls in all selected households. Non-
pregnant women will only be enrolled in every second household.

Table 94.Assumptions and results of sample size calculation, including conversion to number of households, and the anemia precision obtained by the
planned sample size of 3465 households, by target group, taking into account household and individual response rates

# HHs # PSC in Anemia # NPW in Anemia # PW in Anemia # SAC in Anemia # AG in Anemia

# HHs
consen- enrolled precision enrolled precision enrolled precision enrolled precision enrolled precision
selected
ting HHs PSC HHs NPW HHs PW HHs SAC HHs AG
Bishkek city 555 513 133 ±11.1 332 ±9.2 37 -- 133 ±10.5 89 ±12.6
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

Batken oblast 330 310 196 ±9.2 263 ±10.4 23 -- 174 ±9.0 86 ±12.6
Chui oblast 375 366 146 ±10.4 267 ±10.4 27 -- 161 ±9.8 91 ±12.6
Jalal-Abad oblast 375 372 219 ±7.9 305 ±9.4 27 -- 184 ±8.6 98 ±11.6
Naryn oblast 345 332 154 ±10.2 247 ±10.9 24 -- 174 ±9.4 109 ±11.5
Osh oblast 360 354 234 ±8.1 353 ±9.1 26 -- 215 ±8.1 144 ±9.9
Talas oblast 300 299 159 ±9.9 233 ±11.3 22 -- 190 ±9.4 98 ±12.3
Issyk-Kul oblast 405 404 150 ±10.4 271 ±10.6 29 -- 200 ±9.2 118 ±11.3
Osh city 420 407 222 ±7.4 355 ±7.1 30 -- 203 ±6.7 94 ±9.6
NATIONAL 3465 3358 1615 ±3.9 2627* ±3.4 245 ±8.2 1634 ±3.2 927 ±4.1
* NPW only enrolled in every second household. Estimated number of eligible NPW is 1313.
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

**Estimated prevalence and design effect are from most recently available data or, if data not available, 50% prevalence was assumed to maximize sample size
***The required number of children, adolescent girls and women was converted to the number of households to select. The number of households selected per stratum was based on stratum specific household sizes, household
compositions and respond rates reported by the MICS 2018.
 REPORT- OCTOBER 2022

8.9. ETHICAL APPROVAL

175
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

176
REPORT- OCTOBER 2022

177
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

8.10. INFORMATION SHEET AND CONSENT FORM

INFORMATION SHEET (FOR THE PARTICIPANT TO KEEP)

Title of Study: National Integrated Micronutrient and Anthropometric Survey in the
Kyrgyz Republic (NIMAS)
Principal Investigators: Bermet Sydygalieva (UNICEF The Kyrgyz Republic)
Certified Protocol Number ВЫПИСКА ИЗ ПРОТОКОЛА, No. 4

General Information

The National Integrated Micronutrient and Anthropometric Survey in the Kyrgyz Republic 2021 is conducted to
understand the severity of various nutritional deficiencies, such as anemia, iron deficiency, vitamin A deficiency,
and under- and overweight in children, adolescent girls and women. The survey is being conducted by UNICEF,
World Food Programme, Mercy Corps, and GroundWork (a Swiss-based organization). The survey is supported
by Ministry of Public Health of the Kyrgyz Republic.

We will ask questions about your household, and if there are selected children, adolescent girls or women
living in the household, we will ask individual questions to better understand their person and their food habits.

We would very much appreciate your participation in this survey. This information will help the Government
to plan health services. The questionnaire for you usually takes about 30 minutes to complete. Whatever
information you provide will be kept strictly confidential and will not be shown to other persons.

Following the completion of the household and individual questionnaires, we will measure height and weight
and request to draw a small amount of blood from all young children 6 to 59 months of age, school age children
aged 5-9 years, adolescent girls 10-18 years of age and women 19-49 years of age in a dedicated place near
your household. This small blood sample will be used to test each individual’s anemia status, and these results
will be provided to you directly. In addition, a small portion of blood will be collected to test for deficiencies
in iron, folate, vitamin D, and vitamin A status; urine will be collected from adolescent girls and women to
measure iodine concentration.

Further, we will take a salt sample to measure the iodine concentration in the salt and from some households
a flour sample to measure iron concentration.

Benefits/Risk of the study

For children 6-59 months of age and school age children, 4 mL of blood will be collected. For adolescent girls
and women, 6 mL of blood will be collected. Blood will be collected from the arm vein using a needle by trained
technicians. The blood draw should take less than 5 minutes, and the anemia results will be provided in less
than 5 minutes following the taking of blood, and should you be diagnosed with severe anemia, we will provide
you with a referral to a nearby health facility for further testing and treatment. This survey poses no serious
risks to you or other participating family members.

Other than the information about your hemoglobin levels and referral in case of diagnosis of severe anemia, we
cannot promise that the survey will help you directly. But the information collected will help the Government to
evaluate and improve its nutrition and health services.

Confidentiality

All information which is collected about you and your household during the course of the interview will be kept
strictly confidential, and any information about you and the household address will not be included in the final
report so that you cannot be recognized.

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Only the personnel doing the interview and the principal researchers will have access to identifiable information
and by providing your signature/thumbprint, you allow the research team to do so.

Compensation

Your participation in this interview is important and we do appreciate the time made available. As mentioned
earlier, should you/your child be diagnosed with severe anemia or severe malnutrition, we will let you know
and fill in a referral form for you to seek treatment. Further, your household will be compensated with 250 g
of salt.

Withdrawal from Study

Participation in this survey is voluntary, and if we should come to any question you do not want to answer,
just let me know and I will go on to the next question; or you can stop the interview at any time, without any
consequences to you or your household. However, we hope that you will participate in this survey since your
views are important. There will not be any negative effects on you, if you decide that you no longer want to
continue with the interview.

If you are younger than 18 years, your legal parent will have to give signed consent for your participation. This
information sheet will be for you/your caretaker to keep. If you have any question, do not hesitate to contact
the principal researchers.

Contact for additional Information

If you have any questions about the study, you are welcome to call Mrs. Bermet Sydygalieva, from UNICEF
Uzbekistan, who oversees this study, on +996 777919104 and she will be happy to answer your questions.

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NIMAS - WRITTEN INFORMED CONSENT FORM

Complete this form for one person only;

do NOT put information from 2 or more people on the same form!!

VOLUNTEER AGREEMENT
a. Participation of individual below 18 years of age

“I have read or have had someone read all information on the information sheet, have asked questions, received
answers regarding participation in this study, and am willing to give consent for my child/ward to participate in
this study. I have not waived any of my rights by signing this consent form. Prior to signing this consent form, I
was given a copy of the information sheet for my personal records.”

Name of mother or legal caregiver (if respondent is a minor)

Signature or mark of mother or legal caregiver Date

b. Adult woman’s own participation

“I have read or have had someone read all information on the information sheet, have asked questions, received
answers regarding participation in this study, and am willing to give consent to participate in this study. I have
not waived any of my rights by signing this consent form. Prior to signing this consent form, I was given a copy
of the information sheet for my personal records.”

Name of participant

Signature or mark participant Date

CLUSTER ID: RESPONDENT Label: W

HH Label: H RESPONDENT Label: S

RESPONDENT Label: P

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If selected individual or caretaker of a minor (heretofore “volunteer”) cannot read the form themselves, a
witness must sign here:

I was present while the benefits, risks and procedures were read to the volunteer. All questions were answered
and the volunteer has agreed to take part in the research.

Name of witness

Signature of witness Date

I certify that the nature and purpose, the potential benefits, and possible risks associated with participating in
this research have been explained to the above individual.

Interviewer ID
Name of Interviewer who obtained Consent

Signature of Interviewer who obtained Consent Date

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8.11. AUTHORIZATION LETTER FROM MINISTRY OF HEALTH

182
 8.12. TEAMS, TEAM MEMBERS, AND SUPERVISORS
Team Num-
Stratum Supervisors Team leader Interviewers Anthropometrist Phlebotomist
ber
Batken oblast Babakulova B. Suyuyunova, M. Millaeva, O. K. Ismanovna D. Chalbaeva
Maatkaziev Nooruz Madimarov, Meerim
Ashirali, Ismatulaeva, D.
Joosheva, Kanzada, R. Topchilova,
N.Eralieva, M. Ormonova,
Z. Anarbayeva,A. Saykalova,
M. Polotova, Subakulova,
Baymuratova, M. Baratova, B.
Kamchieva, Daleyva, Toychieva.
Jalal-Abad oblast A.Tolgunbaeva, A. Seyitova, M. I. G. Aleksandrovich G.S Seydakmatova
Toktorova, G. Khyrmamatova,
Z. Shamshidinova, F.
Abdrakhmanova, B. Bazarkulova,
G. Aserbekova, K. Shamuratova,
T. Usupbekova, K. Moldalieva,
Z. Israilshanova, Z. Ryskulova,
G. Atembekova, A. Chotonova,
M. Kuzieva, N. Ubraimaliyeva,
Z. Matieva, C. Yndiyeva, C.
Karmysheva, G. Namanova,
B. Temirova, N. Borubaeva, G.
Abdymomunova.
Issyk-Kul oblast A. Dyushebayeva, B. Mambetov, G.S. Sydygalieva Z. Cholponbaeva
M. Dumanaeva, V, Sydykova, G.
Gurinova. B. Omurakanova, T.
Tyulegenov, Z. Sansyzbayeva, A.
Kerimova, A. Kurmanalieva, Z.
Gorbunova, D. Sultanaliyeva, A.
Mamytova, M. Abdullayeva, M.
Adilbekova, C. Baizakova
Naryn oblast G. Zhumvayeva, G. Akmatova, A.I. Idrisova N. Toktaliyeva
Z. Duishebayeva, B.
Mambetkulova, S. Tokoy Kyzy, G.
Nazarmmambetova,

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 N. Mambetalieva, R. Abrazakova,

184
S. Moldobaeva, A. Moldogazieva,
Z. Koboeva, G. Gulyashova, M.
Myrzakanova, S. Zhusupbekova,
V. Kadieva, K. Kockonbaeva,
N. Akylbek, Z. Iskakova, Z.
Kasymova, A. A. Turganbaeva, N.
Beishkeeva, G. Kalyeva.
Osh oblast K. Sadykova, U. Buranova, R. V.B. Torobaev I.A. Mamademinova
Abdullayeva, Z. Dukenbaeva,
B. Rakhimbayeva, A. Mahabat,
E. Umarova, T. Mukashova, A.
Syrdalieva, G. Kamalova, M.
Abdullaeyva, M. Nazhimova,
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

N. Toyaly, R. Zhakypova, M.
Razzakova, T. Koibagarocv,
A. Samiev, B. Kaznagiyeva,
U. Aftandilova, T. Otonova, N.
Matraimova, M. Urazaliyeva, S.
Saparova.
Talas oblast G. Duishenalieva, A. Bolotbekova, M.T. Akmatova A. Shabdanbekova
G. Abdrakhmanova, E.
Askarbekova, R. Satymkulova,
N. Kutmanova, G. Omusheva,
J. Imanova, S. Alymkulova, Z.
Batyrbekova, T. Kozhobekova, Z.
Beisobayeva, A. Shabdanova, A.
NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY

Abdrakhmanova, D. Estebesova,
D. Chormonova, A. Akisheva, Z,
Tazamieva.
Chui oblast B. Omuralieva, N. Toktogulova, A.T. Matkeeva A. Rysbekova
E. Iskakova, K. Doolokeeva,
N. Kalpayeva, N. Bazarbek, S.
Aliyeva, M. Zhusupova, A. Ikanova,
A. Sharsheeva, A. Attokurova, Z.
Kubatbekova, S. Tezekbayeva,
A. Anepova, Z. Dzhakshybayeva,
T. Bozterieva, R. Adylbekova, N.
Sarybayeva, G. Alymbekova,
 M. Dzhumabayeva, B.
Satybaldieva, K. Tynalieva, N.
Gavrilova, R. Baysalbayeva, K.
Radjabov.
Bishkek city Z. Kazieva, A. Almanbetva, Z. E.K. Zhumalieva N. Beishebayeva
Abylbayeva, A. Satarova, A. Maatkazievna
Taichieva, M. Tilenbaeva, C.
Imankanova, N. Zhientaeva,
N. Zhikentayeva, A. Musurova,
Kaikieva, N. Kurzhunbaeva,
N. Kurmankulova, N.
Beksultanova, C. Abdykerimova,
G. Niyazova, S. Malbaeva,
Mamasaitova, N. Kamenikova,
F. Batyr, R. Tookeeva, A.
Osmonkulova, K. Zhunusalieva,
Aidarova, Kenzhebayeva,
Zhuraeva, Toktogulova, B.
Asel, Kurmanbekova, M.
Taabaldiyeva, A. Derkenbayeva,
Rakhmatildaeva, M. Aitkulova,
G. Monkoeva, Makambayeva,
Mirdzhalilova.
Osh city C. Abdraimova, Z. Kazakbaeva, M. Ibragimova B. Akmatova
A. Monokbayeva, N. Tugolova,
B. Shankaeva, D. Arapova, M.
Kirgizbaeva, S. Tursunova, Z.
Matmusaeva, K. Baimaeva,
S. Zulpieva, S. Gulamova, S.
Masaitova, T. Madumarova,
U. Nurperi, K. Tokoeva, K.
Makhmudova, N. Tugolova, N.
Ganieva.

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NATIONAL INTEGRATED MICRONUTRIENT AND ANTHROPOMETRY SURVEY
OF THE KYRGYZ REPUBLIC 2021 (NIMAS)

8.13. SURVEY QUESTIONNAIRES

NIMAS HOUSEHOLD QUESTIONNAIRE

Kyrgyz:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_household_questionnaire-kyr.pdf

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_household_questionnaire-ru.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_household_questionnaire.pdf

NIMAS CHILDREN 6-59 MONTHS QUESTIONNAIRE

Kyrgyz:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_preschool_children_questionnaire-kyr.pdf

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_preschool_children_questionnaire-en.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_preschool_children_questionnaire.pdf

NIMAS CHILDREN 5-9 YEARS QUESTIONNAIRE

Kyrgyz:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_school_age_children_questionnaire-kyr.pdf

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_school_age_children_questionnaire-ru.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_school_age_children_questionnaire.pdf

NIMAS WOMEN/ ADOLESCENT GIRLS QUESTIONNAIRE

Kyrgyz:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_women_questionnaire-kyr.pdf

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_women_questionnaire-ru.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/nimas_women_questionnaire.pdf

NIMAS CHILDREN 6-59 MONTHS BIOLOGICAL FORM

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/10.6_RU_NIMAS_PSC-biological-form-210918.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/10.6_EN_NIMAS_PSC-biological-form-210918.pdf

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NIMAS CHILDREN 5-9 YEARS BIOLOGICAL FORM

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/10.7_RU_NIMAS_SAC-biological-form-210918.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/10.7_EN_NIMAS_SAC-biological-form-210918.pdf

NIMAS WOMEN/ ADOLESCENT GIRLS BIOLOGICAL FORM

Russian:
https://groundworkhealth.org/wp-content/uploads/2022/10/10.5_RU_NIMAS_Woman-Adolescent-girl-biological-
form-210918.pdf

English:
https://groundworkhealth.org/wp-content/uploads/2022/10/10.5_EN_NIMAS_Woman-Adolescent-girl-biological-
form-210908.pdf

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8.14. REFERRAL FORM

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8.15.ANTHROPOMETRY – NIMAS: ENA PLAUSIBILITY CHECK REPORT

Plausibility check for: NIMAS_Anthro ENA for PSC_v4.as

СтанYesрт/рекоменYesции, исSexьзованные для расчета z-оценки: СтанYesрты ВОЗ 2006/Standard/
Reference used for z-score calculation: WHO standards 2006

1. Overall data quality:

Criteria Flags* Unit Excel. Good Accept Problematic Score

Flagged data Incl % 0-2.5 >2.5-5.0 >5.0-7.5 >7.5
(% of out of range subjects) 0 5 10 20 0 (1.7 %)
Overall Sex ratio Incl p >0.1 >0.05 >0.001 <=0.001
(Significant chi square) 0 2 4 10 0 (p=0.899)
Age ratio(6-29 vs 30-59) Incl p >0.1 >0.05 >0.001 <=0.001
(Significant chi square) 0 2 4 10 0 (p=0.890)
Dig pref score - weight Incl # 0-7 8-12 13-20 > 20
0 2 4 10 0 (3)
Dig pref score - height Incl # 0-7 8-12 13-20 > 20
0 2 4 10 2 (9)
Standard Dev WHZ Excl SD <1.1 <1.15 <1.20 >=1.20
- and and and or
- Excl SD >0.9 >0.85 >0.80 <=0.80
0 5 10 20 0 (0.93)
Skewness WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6
0 1 3 5 0 (0.08)
Kurtosis WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6
0 1 3 5 0 (0.05)
Poisson dist WHZ-2 Excl p >0.05 >0.01 >0.001 <=0.001
0 1 3 5 0 (p=0.487)
OVERALL SCORE WHZ = 0-9 10-14 15-24 >25 2%

The overall score of this survey is 2 %, which is excellent.

2. Duplicate entries: There were no duplicate entries detected.

There were no duplicate entries detected.

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3. Age distribution:

Age distribution
Age distribution for children for
6-59children
months6-59 months
of age, of age,Republic
the Kyrgyz the Kyrgyz Republic 2021
2021
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31
Age in months

31
Age in months

32 32
33 33
34 34
35 35
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
46 46
47 47
48 48
49 49
50 50
51 51
52 52
53 Age ratio of 6-29
53 months to 30-59
54 54
55 months: 0.84 (The value
55 should be around 0.85).:
56 56
57 57
p-value = 0.890 (as
58 58
59 expected)
59
0 5 010 515 1020 1525 20 30 25 35 3040 3545 40 50 45 50

Frequency Frequency

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4. Statistical evaluation of sex and age ratios (using Chi squared statistic):

Age cat. mo. boys girls total ratio boys/girls

6 to 17 12 176/179.5 (1.0) 165/180.7 (0.9) 341/360.2 (0.9) 1.07
18 to 29 12 176/173.3 (1.0) 192/174.4 (1.1) 368/347.6 (1.1) 0.92
30 to 41 12 166/169.7 (1.0) 191/170.8 (1.1) 357/340.4 (1.0) 0.87
42 to 53 12 188/167.0 (1.1) 140/168.0 (0.8) 328/335.0 (1.0) 1.34
54 to 59 6 66/82.6 (0.8) 89/83.1 (1.1) 155/165.7 (0.9) 0.74
6 to 59 54 772/774.5 (1.0) 777/774.5 (1.0) 0.99

The data are expressed as observed number/expected number (ratio of obs/expect)

Overall sex ratio: p-value = 0.899 (boys and girls equally represented)

Overall age distribution: p-value = 0.424 (as expected)

Overall age distribution for boys: p-value = 0.187 (as expected)

Overall age distribution for girls: p-value = 0.031 (significant difference)

Overall sex/age distribution: p-value = 0.002 (significant difference)

5. Digit preference Weight:

Digit preference for weight for children 6-59 months of age, the Kyrgyz Republic 2021
180

140
Frequency

100

80

40

0
0 1 2 3 4 5 6 7 8 9
Digit

Digit preference score: 3 (0-7 excellent, 8-12 good, 13-20 acceptable and > 20 problematic)

p-value for chi2: 0.410

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6. Digit preference Height:

Digit preference for height for children 6-59 months of age, the Kyrgyz Republic 2021
200

180

140
Frequency

100

80

40

0
0 1 2 3 4 5 6 7 8 9
Digit

Digit preference score: 9 (0-7 excellent, 8-12 good, 13-20 acceptable and > 20 problematic)

p-value for chi2: 0.000 (significant difference)

Evaluation of Standard deviation, Normal distribution, Skewness and Kurtosis using the 3 exclusion (Flag)
procedures
exclusion from exclusion from
no exclusion reference mean observed mean
(WHO flags) (SMART flags)
WHZ
Standard Deviation SD:
(The SD should be between 0.8 and 1.2) 1.17 1.01 0.93
Prevalence (< -2)
observed: 1.1% 1.0%
calculated with current SD: 1.3% 0.6%
calculated with a SD of 1: 0.5% 0.5%
HAZ
Standard Deviation SD:
(The SD should be between 0.8 and 1.2) 1.46 1.28 1.04
Prevalence (< -2)
observed: 7.5% 7.3% 6.8%
calculated with current SD: 13.8% 11.1% 7.8%
calculated with a SD of 1: 5.7% 5.8% 7.0%
WAZ
Standard Deviation SD:
(The SD should be between 0.8 and 1.2) 1.03 0.99 0.95
Prevalence (< -2)
observed: 1.0%
calculated with current SD: 1.7%

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calculated with a SD of 1: 1.5%

Results for Shapiro-Wilk test for normally (Gaussian) distributed data:
WHZ p= 0.000 p= 0.000 p= 0.071
HAZ p= 0.000 p= 0.000 p= 0.034
WAZ p= 0.000 p= 0.000 p= 0.094
(If p < 0.05 then the data are not normally distributed. If p > 0.05 you can consider the data normally distributed)
Skewness
WHZ 2.24 -0.25 0.08
HAZ 1.36 0.87 0.15
WAZ 0.94 0.29 0.09
If the value is:
• below minus 0.4 there is a relative excess of wasted/stunted/underweight subjects in the sample
• between minus 0.4 and minus 0.2, there may be a relative excess of wasted/stunted/underweight subjects in
the sample.
• between minus 0.2 and plus 0.2, the distribution can be considered as symmetrical.
• between 0.2 and 0.4, there may be an excess of obese/tall/overweight subjects in the sample.
• above 0.4, there is an excess of obese/tall/overweight subjects in the sample
Kurtosis
WHZ 33.72 1.86 0.05
HAZ 12.65 2.71 -0.08
WAZ 7.03 0.61 -0.06
Kurtosis characterizes the relative size of the body versus the tails of the distribution. Positive kurtosis indicates
relatively large tails and small body. Negative kurtosis indicates relatively large body and small tails.
If the absolute value is:
• above 0.4 it indicates a problem. There might have been a problem with data collection or sampling.
• between 0.2 and 0.4, the data may be affected with a problem.
• less than an absolute value of 0.2 the distribution can be considered as normal.

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8.16. DESIGN EFFECTS OF MAJOR OUTCOMES

Variable Number in analysis Design effect
Household
Improved water source 3,060 6.96
Improved sanitation 3,058 2.29
Salt adequately fortified 2,863 1.45
Wheat flour fortified 704 1.66
Children 6-59 months of age
Low birth weight 1,442 1.47
Had diarrhea in past 2 weeks 1,535 1.79
Had fever in past 2 weeks 1,544 1.82
Had LRI in past 2 weeks 1,546 1.93
Early initiation of breastfeeding 473 1.08
Currently breastfeeding 472 1.03
Minimum dietary diversity 489 1.45
Anemia 1,211 2.04
Iron deficiency 1,161 1.68
Vitamin A deficiency 1,161 1.75
Vitamin D deficiency 394 1.57
Children 5-9 years of age
Low birth weight 1,508 1.33
Had diarrhea in past 2 weeks 1,729 1.55
Had fever in past 2 weeks 1,728 1.46
Had LRI in past 2 weeks 1,730 2.94
Minimum dietary diversity 1,730 1.71
Anemia 1,401 2.05
Iron deficiency 1,388 2.13
Vitamin A deficiency 1,388 2.15
Adolescent girls 10-18 years
Took folic acid supplement in past 6 months 991 2.06
Took iron supplement in past 6 months 987 2.32
Took multi-vitamin supplement in past 6 months 990 1.57
Anemia 858 1.89
Iron deficiency 822 2.18
Vitamin A deficiency 822 1.56
Folate deficiency 824 1.87
Vitamin D deficiency 201 1.34
Non-pregnant women 15-49 years
Took folic acid supplement in past 6 months 1,375 1.15
Took iron supplement in past 6 months 1,375 1.72
Took multi-vitamin supplement in past 6 months 1,371 1.85
Overweight or obesity 1,189 1.73
Anemia 1,203 1.66
Iron deficiency 1,149 1.99
Vitamin A deficiency 1,149 1.31

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Folate deficiency 1,163 1.62
Vitamin D deficiency 315 1.34
Pregnant women
Took folic acid supplement in past 6 months 171 1.38
Took iron supplement in past 6 months 171 1.21
Took multi-vitamin supplement in past 6 months 172 0.99
Undernutrition (i.e., MUAC<23 cm) 131 1.47
Anemia 140 1.22
For every child
Whoever she is.
Wherever he lives.
Every child deserves a childhood.
A future.
A fair chance.
That’s why UNICEF is there.
For each and every child.
Working day in and day out.
In more than 190 countries and territories.
Reaching the hardest to reach.
The furthest from help.
The most excluded.
It’s why we stay to the end.
And never give up.

The United Nations Children’s Fund (UNICEF)

160, Chui Ave., 720040, Bishkek
Kyrgyz Republic
Telephone: 996 312 611 211 + ext.

bishkek@unicef.org
www.unicef.org/kyrgyzstan
www.facebook.com/UNICEFKyrgyzstan
www.twitter.com/unicefkg
www.instagram.com/unicefkg

© The United Nations Children’s Fund (UNICEF), October, 2022